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Dr K K Aggarwal

Alcohol: Benefits vs. Risks

By Dr K K Aggarwal
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  • There is consensus that non-drinkers should not start and the ones who drink can continue provided they do so in moderation and in absence of contraindications.
  • Persons who have been lifelong abstainers cannot be easily compared with moderate or even rare drinkers. Recommending alcohol intake to non-drinkers, even if they would agree to drink, is not justified.
  • The diseases that moderate alcohol use prevents (such as coronary heart disease, ischemic stroke, and diabetes) are most prevalent in the elderly, men, and people with coronary heart disease risk factors. For these groups, moderate alcohol use is associated with a considerable mortality benefit relative to abstention or rare drinking.
  • For young to middle-aged adults, especially women, moderate alcohol use increases the risk of the most common causes of death (such as trauma and breast cancer).
  • Women who drink alcohol should also take supplemental folate to help decrease the risk of breast cancer.
  • Men below 45 years of age may also experience more harm than benefit from alcohol consumption. In this age group, moderate alcohol use is not likely to provide any mortality benefit, but consumption of less than one drink a day appears to be safe if temporally removed from operation of dangerous equipment. For individuals with established contraindications to alcohol use, even this level of alcohol use is dangerous.
  • Men can tolerate more alcohol than women. The ideal therapeutic dose of alcohol is around 6 g per day. Medically safe limits are 10 g in one hour, 20 g in a day and 70 g in a week (50% for women).

Treatment of acute leg cramps

By Dr K K Aggarwal
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Patients with an acute leg cramp should forcefully stretch the affected muscle, for example, by active dorsiflexion of the foot with the knee extended, for a cramp is in the calf.

Some patients may find relief from passive stretching by getting out of bed and standing with the foot flat on the floor and pressing downward firmly. However, active dorsiflexion of the foot may be more effective.

Other measures that may bring relief from the acute cramp include:

  • Walking or leg jiggling followed by leg elevation
  • A hot shower with the stream directed at the cramp area, for about five minutes, or a warm tub bath
  • Ice massage.

Treatment of fatty liver

By Dr K K Aggarwal
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  • A 10% weight loss can improve fatty liver and possibly inflammation.
  • Metformin and ursodeoxycholic acid (UDCA) are not recommended.
  • Statins are safe in patients with fatty liver but whether they can reduce fatty liver is not known.
  • Omega-3 fatty acids have been tried.
  • Pioglitazone is useful in the treatment of biopsy-proven fatty liver with inflammation.
  • Vitamin E at a dose of 800 IU/day improves liver inflammation.
  • Use of bariatric surgery for treatment of fatty liver is premature and should be avoided in patients with cirrhosis.

Explaining cardiac interventions

By Dr K K Aggarwal
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For any traffic management, following are the options:

  • Placing traffic signals can be equated to dos and don’ts of lifestyle management.
  • Posting a traffic inspector on the crossing – This can be equated with clinical cardiologist.
  • Diverting the traffic from main road to side roads – This can be equated to opening collaterals by drugs, exercise.
  • Hiring an architect to make maps – This can be equated to an angiographer doing angiography.
  • Looking for the possibility of widening the roads – This can be equated to balloon angioplasty.
  • To prevent encroachment of widened roads to place railing around the widened roads can be equated to placement of metallic stent.
  • To prevent mishandling of railing, safety grills are put. This can be equated to drug eluting stents.
  • When the roads cannot be widened, flyovers are made, which can be equated to bypass surgery.
  • Flyovers can be made by stopping the traffic. This can be equated to open bypass surgery.
  • Flyovers can be made without disturbing the traffic, this can be equated to heart bypass surgery.

Eating refined sugar can cause diabetes

By Dr K K Aggarwal
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Eating too much refined white sugar can cause insulin resistance and future diabetes.

Diabetes does not mean that one cannot have desserts forever. While eating too many sugary foods should be avoided, one can have an occasional dessert, especially if one exercises and otherwise eats healthy. It’s better to substitute brown sugar or Jaggery in that case. Artificial sweeteners including stevia are the other options.

Fruits are healthy for diabetics but cannot be consumed in huge amounts, as they contain carbohydrates.

As per Ayurveda, diabetes is a Kapha disorder and diabetics should limit the intake of sweet, salt and sour taste in the diet. Any fruit or vegetable, which is bitter and dark green, has anti-diabetic properties.

One should combine a bitter taste with a sweet taste when choosing a vegetable or a fruit. For example, one should not combine peas with potatoes but one can combine potatoes with fenugreek (methi) leaves or spinach (palak).

Diabetics are not more susceptible to colds and other illnesses but may have more complications of flu.

Taking insulin does not cause hardening of the arteries or high blood pressure.

Diabetes is not contagious and one cannot catch diabetes from someone else.

How to keep your memory sharp?

By Dr K K Aggarwal
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  • Manage your stress, especially deadline pressure and petty arguments.
  • The biggest stress is an ongoing sense of extreme anxiety. This can be managed by deep breathing, meditation, yoga and by mindful approach to living.
  • Get a good night’s sleep. The most common reason for poor sleep is difficulty in falling asleep and staying asleep. Many drugs used to treat insomnia can also impair memory.
  • If you need a sleeping medicine, it should be used in the lowest dose and for the shortest period of time.
  • Get up at the same time in the morning.
  • If you smoke, quit.
  • If you do not drink, do not start.
  • Alcohol makes it difficult to perform short-term memory tasks such as memorizing a list. It also induces vitamin B1 deficiency, which can cause dementia.
  • Protect your brain from injury as repeated minor head trauma can cause brain damage.
  • Wear seat belt when riding in a motor vehicle.
  • Wear helmet while driving or riding a motorcycle.

Tips on Water Hygiene

By Dr K K Aggarwal
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  • Travelers should avoid consuming tap water.
  • Avoid ice made from tap water.
  • Avoid any food rinsed in tap water.
  • Chlorination kills most bacterial and viral pathogens.
  • Chlorination does not kill Giardia and Entamoeba cysts or Cryptosporidium.
  • Boiled/treated water is safe.
  • Carbonated drinks, wine and drinks made with boiled water are safe.
  • Freezing does not kill the organisms known to cause diarrhea. Ice in drinks is not safe unless it has been made from adequately boiled or filtered water.
  • Alcohol does not sterilize water or ice. Mixed drinks may still be contaminated.
  • Hot tea and coffee are the best alternates to boiled water.
  • Bottled drinks should be requested without ice and should be drunk from the bottle with a straw rather than with a glass.
  • Boiling water for 3 minutes followed by cooling to room temperature will kill bacteria.
  • Adding two drops of 5% sodium hydrochloride (bleach) to quarter of water (1 liter) will kill most bacteria in 30 minutes.
  • Adding 5 drops of tincture of iodine to 1 liter of water will kill bacteria within 30 minutes.

Clinicians should aggressively treat unhealthy lifestyles

By Dr K K Aggarwal
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Unhealthy behaviors should be managed as aggressively as hypertension, high cholesterol, and other heart disease risk factors, according to an American Heart Association policy statement published in the journal Circulation.

Doctors should create “interprofessional practices” to connect patients with behavior-change specialists. They must implement five A’s when caring for patients –

  1. Assess a patient’s risk behaviors for heart disease
  2. Advise change, such as weight loss or exercise
  3. Agree on an action plan
  4. Assist with treatment
  5. Arrange for follow-up care.

Cough Hygiene

By Dr K K Aggarwal
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  • When you cough or sneeze, you tend to expel out respiratory waste, which can be droplets (larger than 5 micron) or airborne droplets less than 5 micron; both have different clinical implications.
  • Droplets remain suspended in the air for a limited period only and exposure of less than 3 feet is usually required for human-to-human transmission of droplet-borne respiratory organisms. In flu, this can be up to 6 feet. The examples of droplet infections are meningitis, influenza, rubella (German measles), etc.
  • No precaution needs to be taken by a person who is 6-10 feet away from the patient but if a person is sitting or working at even 3-6 feet distance, the non-coughing person should wear a simple mask.
  • Airborne droplet nuclei that carry respiratory secretions smaller than 5 microns can remain suspended in the air for extended period and can cause infections to people who are standing even more than 10 feet away. The examples of airborne droplet nuclei infections are TB, measles, chickenpox and SARS.
  • Patients with these diseases should be placed in an isolation room and all healthcare personnel who are looking after these patients must use a safe N95 mask.
  • In normal house with windows opened, there is a constant exchange of air, which prevents spread of infections but in AC setups with no air exchange, the infections can spread from one person to another.
  • When sitting in an air-conditioned atmosphere, the setting of the AC should be such that the same air is not circulated and fresh air is allowed to exchange. Split ACs, therefore, are more dangerous than the window ACs.
  • In an office with split AC, if one employee is suffering from any of the droplet nuclei disease, he/she can transmit infection to others. Therefore, patients with confirmed TB, measles, chickenpox and SARS should not be allowed to work in split AC atmosphere.

Tips to relieve heartburn

By Dr K K Aggarwal
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  • Avoid foods that seem to trigger your symptoms.
  • Eat small portions and dont overeat; chew food slowly and completely.
  • Avoid smoking, eating quickly, chewing gum, and drinking carbonated beverages as they lead to swallowing excess air.
  • Reduce stress.
  • Get enough rest.
  • Dont lie down within 2 hours of having a meal.
  • Maintain a healthy body weight.

(Source: Harvard Healthbeat)

Hand, foot and mouth disease: Salient facts

By Dr K K Aggarwal
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  • Hand, foot and mouth disease is a viral illness most commonly caused by the Coxsackie virus A6.
  • Enteroviruses 71 (EV71) can also cause hand, foot and mouth disease.
  • Both adults and children can develop this infection. But young children below 5 years old are more susceptible.
  • It is a moderately contagious illness.
  • The incubation period is 5 days.
  • The illness begins with fever, which lasts for 24-48 hours.
  • Fever is followed by appearance of painful sores in mouth. They begin as small red spots that blister and then often become ulcers. Tongue is involved.
  • There is peripherally distributed, small, tender, non itchy rash with blisters on palms of the hands, and soles of feet and buttocks.
  • The sores hurt on touch and swallowing is difficult.
  • There is proximal separation of nail from the nail bed.
  • The virus is present in mucus from nose, saliva, fluid from sores and traces of bowel movements.
  • The virus spreads in the first week of infection.
  • The infection spreads from person to person by direct contact with nasal discharge, saliva or blister fluid or from stool of infected persons.
  • The virus can persist in the stool for weeks.
  • The illness is not transmitted to or from pets or other animals.
  • The illness stays for 2-3 days. It is usually mild and self-limited.
  • Enterovirus 71 is associated with brain involvement (meningitis and encephalitis), lungs and the heart.
  • The patient remains infectious after the symptoms have gone.
  • Test is not necessary.
  • There is no specific treatment.
  • Paracetamol tablet can be taken to relieve pain and fever.
  • Aspirin is to be avoided in children.
  • Avoid dehydration.
  • Eat ice cream to numb the pain.
  • Use mouthwashes or sprays that numb the mouth.
  • Regularly wash your hands with soap and water.
  • Avoid exposure to infected person.
  • Maintain touch hygiene to reduce your risk of acquiring the infection.
  • During first week of illness, the child should be kept in isolation.
  • Schools should be closed.
  • There is no vaccine currently available.

Tips to prevent water-borne diseases this monsoon

By Dr K K Aggarwal
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  • Drink only filtered/boiled water.
  • Store water in a clean container.
  • Wash water containers daily.
  • Always wash hands before and after preparing food and eating. Educate children about the importance of washing hands effectively and regularly.
  • Wash hands with soap or use hand sanitizers after using a washroom, changing a childs diaper, or after visiting unclean and infection-prone areas, such as public washrooms, hospitals, etc.
  • Consume warm and home cooked foods and avoid street food.
  • Wash vegetables thoroughly before cooking.
  • Always keep foods/beverages covered.
  • The pipes and tanks that supply water to your house should be properly maintained and clean.
  • Travelers should only drink bottled water and avoid uncooked food.
  • People suffering from water-borne diseases should not go to work until they are fully recovered to avoid spreading the infection.
  • Avoid using ice made from tap water.
  • Freezing does not kill the organisms that cause diarrhea. Ice is not safe unless it is made from adequately boiled or filtered water.
  • Alcohol does not sterilize water or ice. Mixed drinks may still be contaminated.
  • Hot tea and coffee are the best alternates to boiled water.

Some facts on noise levels

By Dr K K Aggarwal
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  • Extended exposure to sounds above 85 db can lead to progressive hearing loss. Anyone exposed to sounds above 85 db of noise requires hearing protection.
  • The special limit for people who are exposed to noise above 90 db is 8 hours, for 95 db is 4 hours and 2 hours for 100 db.
  • A brief blast of loud sound also can result in severe to profound sensorineural hearing loss and pain. This usually involves exposure to noise above 120-155 db. Hearing protection in the form of muffins or ear plugs is recommended whenever a person is exposed to loud noise.

Preventing malaria

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

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.