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Dr K K Aggarwal

OTC drug does not mean it should be taken without a doctor’s advice

By Dr K K Aggarwal
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An over-the-counter (OTC) antacid is often used to relieve mild cases of heartburn or acid reflux. Though they are available without a doctor’s prescription, they should be taken only under a doctor’s advice.
As per the American Academy of Family Physicians –
  • Different types of antacids have different mechanisms of action.
  • To manage an ulcer, an antacid may need to be taken along with an antibiotic.
  • If one needs more calcium to help strengthen bones, an antacid that contains calcium carbonate is preferred.
  • Antacids may cause minor side effects in some, such as nausea, headache, diarrhea or constipation.
  • One must read the label carefully to ensure that he/she is not allergic to any of the ingredients.
  • It may not be feasible for those with kidney disease to take all types of antacids.
  • An antacid may interact with other medications.

What type of a vegetarian are you?

By Dr K K Aggarwal
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There are 4 main types of vegetarian diets:
Lacto–ovo–vegetarian –This involves dairy products and eggs but no meat, poultry, or seafood
Lacto–vegetarian –This encompasses dairy products but no eggs, meat, poultry, or seafood
Ovo–vegetarian –This includes eggs but no dairy products, meat, poultry, or seafood
Vegan does not consume any animal products, including meat, fish, poultry, eggs, and dairy products. Many vegans also avoid honey.
Vegetarian and plant-based diets are associated with a diminished risk of obesity, diabetes, heart disease and certain cancers as well as increased longevity. Vegetarian diets have lower fat content, especially saturated fat, and are rich in dietary fiber. They also include more whole grains, legumes, nuts, soy protein, and are devoid of red meat. Such a diet plan may assist with the prevention and treatment of obesity and chronic health problems, such as diabetes and cardiovascular disease.

Fat but fit no longer good for health

By Dr K K Aggarwal
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A study published in the International Journal of Epidemiology challenged the concept that by being physically fit, individuals who are obese can fully compensate mortality risk. The study suggested that physically fit obese men have a higher risk for death compared to men who are of normal weight but are physically unfit. Additionally, there was a graded association between aerobic fitness at 18 years of age and the risk of early mortality.
The study by Gabriel Högström, Dept. of Community Medicine and Rehabilitation at Umeå University, Sweden, and colleagues, obtained data from the Swedish Military Conscription Registry and included 1,317,713 Swedish men (mean age, 18 years) conscripted into the Swedish military from 1969 to 1996. At the time of conscription, they were subjected to baseline assessments for aerobic fitness testing, wherein they cycled until fatigue set in. Investigators assessed all-cause and cause-specific deaths, using national registers. Mortality information was obtained from the National Cause of Death Registry.
Over a mean follow-up of 28.8 years, 44,301 of them died. After adjustment for age and conscription year, those with the highest aerobic fitness levels were found to have a 51% lower risk for all-cause death compared to those with the lowest fitness levels. Similar findings were seen from analyses of weight-adjusted fitness.
Alcohol and narcotic abuse were found to have the strongest associations with death (HR, 0.20; 95% CI, 0.15 – 0.26).
Obese men obtained lesser benefit than normal-weight men from being physically fit (P < .001). Additionally, normal-weight men in all levels of aerobic fitness had lower risk for all-cause mortality (30% – 48%; P < .05 for all) in comparison with obese men with the highest levels of aerobic fitness.
The benefits of aerobic fitness appeared to decline with increase in weight. After adjusting for age and year, normal-weight men in the upper half of aerobic fitness had 34% lower risk for death compared to those in the lower half (HR, 0.66; 95% CI, 0.64 – 0.68). The benefit was seen to decrease to 28% among overweight men, and disappeared completely in those with the highest levels of obesity… (Medscape)

Some facts on Malaria

By Dr K K Aggarwal
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Transmission of malaria occurs via the bite of a female anophelesmosquito.

·                 The mosquito usually bites from dusk to dawn.

·                 It can also be transmitted through blood transfusion, or sharingof contaminated needles.

·                 Bed nets are good against malaria as the major malarial vectorsbite during the night.

·                The behavior of the mosquitoes may differ. Some may prefer to restindoors and feed indoors in the night. Some mosquitoes may rest and feedoutdoors earlier in the day.

·                 Preventive therapy of malaria can be instituted during pregnancyin high risk areas.

·                 The malaria mosquito feeds every third day compared to the denguemosquito, which feeds three times in a day.

·                 Unlike the malaria mosquito, the dengue mosquito bites during theday.

·                 Fever in malaria presents with chills, especially duringafternoon.

·                 Spraying the walls and ceiling in houses is effective againstmosquitoes.

·                 DDT is commonly used as indoor residential spraying.

·                 DDT should not be applied more than once or twice in a year on thewalls.

·                 Mosquito contact with DDT surface would generally save from lethalexposure outside the house.

·                 People must know that spray may require rearrangement of thefurniture. Walls may become streaked with chemical treatment and residual odorfrom DDT.

·                 The other alternative is malathion spray.

Childhood obesity increasing at an alarming rate around the world

By Dr K K Aggarwal
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The prevalence of obesity among children is increasing at an alarming rate. Overweight four-year-old children have twice the risk of high blood pressure by the age of six years. This heightens the risk of future heart attack and stroke. The World Health Organization (WHO) has listed childhood obesity among the most serious public health challenges of the 21st century.

Obesity is a multifactorial disorder; unhealthy diet – eating foods high in fats, sugar and salt (junk food, processed food) and a sedentary lifestyle (TV, internet, computer and mobile games have taken precedence over outdoor sports) contribute significantly to this escalating epidemic. Women should lose those extra pounds before conceiving, avoid gaining excess weight during pregnancy, and quit smoking, as these are known risk factors for childhood obesity.

Most obese children grow up to have obesity in adulthood. Overweight and obese children are at risk of other lifestyle disorders such as type 2 diabetes, hypertension, dyslipidemia, metabolic syndrome later in life. They are more likely to have joint problems, sleep apnea and social and psychological problems.

Healthy habits in childhood lay a foundation for a healthier adulthood. Here are some tips that parents can follow at home to tackle obesity and unhealthy habits in children:

  • Encourage healthy eating habits right from the begining.
  • Try making the dishes healthier. Few changes can make the snacks healthier.
  • Avoid tempting children with calorie-rich food. Treat them but in moderation and by limiting high-fat and high-sugar or salty snacks.
  • Make kids understand the importance of being physically active.
  • Indulge yourself in at least 60 minutes of moderate to intense physical activity every day and set an example for your kids
  • Reduce sedentary time. While reading is a good option, too much of screen time is not good.
  • Replace screen time with outdoor fun activities to keep children engaged.

Prevention strategy relies on lifestyle

By Dr K K Aggarwal
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Stenting may not always be the answer to treating heart disease with stable angina. A German study has shown that patients with stable CAD who underwent an exercise regimen had significantly higher rates of event-free survival compared to those who were subjected to percutaneous coronary intervention (PCI). In the study, 70% of patients in the exercise program had event-free survival – no stroke, heart attack, or death – compared to 50% of stented patients after a span of four years. Exercise is an important part of any type of prevention, and it should be introduced for anyone with stable coronary heart disease.

The study was a continuation of a pilot study published in 2004 in Circulation. That study included 101 male patients and noted that after one year, 88% of patients who exercised had an event-free survival compared to 70% of stented patients. The updated study present data on an additional 100 patients, who did moderate intensity exercise for two weeks under hospital supervision, which was followed by use of an exercise bike at home. Patients with stable angina exercised at 80% of their threshold, and after four weeks of exercising, their angina threshold increased.

The clear message is to get 30 to 60 min of moderate-intensity aerobic activity every day. About 30% of heart disease could be prevented by 2.5 hours of walking per week.

Types of smokers

By Dr K K Aggarwal
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  • Light: <10 cigarettes per day
  • Heavy: >25 cigarettes per day
  • Chippers: Very light smokers (<5 cigarettes a day); those who regularly use tobacco without developing dependence
  • Light and intermittent smokers: 1-39 cigarettes per week, or an average of 10 cigarettes per day or 1-4 grams of tobacco per day; have never smoked daily
  • Low-level smokers: <20 cigarettes per day and <1 pack per week
  • Low-rate smokers: <5 cigarettes per day; never above 10 cigarettes per day
  • Non-daily smokers: Smoking <7 days per week; may smoke <3 packs a week
  • Occasional smokers: Smoking <5 cigarettes a day and < 3 times a week, often depending on circumstances such as partying or drinking or after meals
  • Social smokers: <5 cigarettes per day and for <7 days per week over the previous two years; have never gone beyond that limit.

Diagnosis of hypertension in childhood calls for repeated BP measurements

By Dr K K Aggarwal
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The diagnosis of hypertension should be confirmed on the basis of three blood pressure measurements at separate clinicvisits.

Normative BP percentiles are based on data on gender, age, height, and blood pressure measurements from the National Health and Nutrition Examination Survey and other population-based studies.

In a study, initial BP measurement was normal (below the 90th percentile), pre-hypertensive (systolic or diastolic BP between the 90th and 95th percentile) and hypertensive (systolic or diastolic BP =95th percentile) in 82%, 13%, and 5% of children, respectively.

At follow-up, subsequent hypertensive levels were observed in 4% of the 10,848 children with initial hypertensive values. The overall prevalence of hypertension in the cohort was found to be 0.3%.

Some tips to avoid dyspepsia from HCFI

By Dr K K Aggarwal
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Identify the triggers. For some individuals, the triggers could be dairy products. It is important to identify the foods that trigger the symptoms and avoid them.

Opt for less gassy foods. It is advisable to avoid beans, cabbage, and cauliflower; these can cause gas. Consume more of foods which have high omega-3 fatty acid content.

Eat smaller meals. This will help the digestive system adjust better to the condition.

Keep yourself hydrated. Drink plenty of water and other fluids. However, limit the consumption of caffeine and alcohol.

Guidelines on Health

By Dr K K Aggarwal
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  • Keep your blood cholesterol less than 160 mg%. Even 1% reduction in cholesterol reduces the chances of heart attack by 2%.
  • Uncontrolled diabetes and blood pressure can precipitate a heart attack. Keep these under check.
  • Eat less, walk more.
  • Regular exercise is good for health. The best exercise is walking, which is brisker than brisk walking.
  • Soya products are good for health. These should form an essential ingredient of the diet.
  • Fruits are better than juices.
  • Brown rice is better than polished rice and jaggery is better than white sugar.
  • Eat high fiber diet.
  • Driving and drinking do not go together.
  • Pregnant women must not drink. It harms the baby in the womb.
  • Get your health check-up done at least once in a year.
  • Salt intake should be restricted.
  • Avoid APC where A stands for achar, P for papad and C for chutney.

Expressive writing can relieve stress

By Dr K K Aggarwal
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One can significantly boost mental and physical health by spending 30 minutes each day for four days to write out the innermost thoughts and feelings.

This so-called expressive writing requires only a pen and a paper.

In expressive writing therapy, patients are encouraged to express whatever is on their mind, letting their hopes and fears flow out in a natural, unrestrained way. It is like keeping a journal, but more focused on the things that might be bothering one or triggering stress.

Guidelines about Eating

By Dr K K Aggarwal
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  • Eat only when you are hungry.
  • Do not eat for pleasure, social obligations or emotional satisfaction.
  • Eat at a slow pace.
  • Eat less; dinner less than lunch.
  • Take small mouthfuls each time; chew each morsel well, swallow it and only then take the next morsel.
  • Do not eat while watching television, driving a car or watching sports events. The mind is absorbed in these activities and one does not know what and how much one has eaten.
  • Do not talk while eating and never enter into heated arguments. The stomach has ears and can listen to your conversation. It will accordingly send signals to the mind and heart.
  • Plan and decide in advance what and how much food you will be eating.
  • Use low fat or skimmed mild dairy products. Use oils which are liquid at room temperature for cooking.
  • Do not take red meat and if you are a non-vegetarian, you may take poultry meat or fish.

Younger women with acute coronary syndromes may not have classic chest pain

By Dr K K Aggarwal
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Younger women with an acute coronary syndrome have slightly lesser likelihood than men to present with the classic symptom of chest pain, reported a study published in JAMA Internal Medicine. As a result, they often fail to receive a correct diagnosis in the emergency department.

Khan and colleagues prospectively evaluated data from over 1,000 ACS patients aged 55 or younger (30% women), participating in the GENESIS PRAXY study.

In these younger patients women had lesser odds of having chest pain, compared to men (19% of women versus 13.7% for men, p = 0.03). Additionally, women were more likely than men to have a non-ST-segment elevation myocardial infarction (37.5% vs 30.7%; p = 0.03).

Multivariate analysis revealed that women and patients with tachycardia had a lesser likelihood of having chest pain. The absence of chest pain did not indicate any change in the type or severity of the ACS.

Diagnosis of any disease with a lower prevalence but higher mortality, such as coronary artery disease in younger women, is more challenging.

Public health messages should focus on both men and women regarding ACS symptom presentation with or without chest pain in order to encourage earlier and more widespread access to lifesaving care.

OTC drug does not mean it should be taken without a doctor’s advice

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on OTC drug does not mean it should be taken without a doctor’s advice

An over-the-counter (OTC) antacid is often used to relieve mild cases of heartburn or acid reflux. Though they are available without a doctor’s prescription, they should be taken only under a doctor’s advice.

As per the American Academy of Family Physicians –

  • Different types of antacids have different mechanisms of action.
  • To manage an ulcer, an antacid may need to be taken along with an antibiotic.
  • If one needs more calcium to help strengthen bones, an antacid that contains calcium carbonate is preferred.
  • Antacids may cause minor side effects in some, such as nausea, headache, diarrhea or constipation.
  • One must read the label carefully to ensure that he/she is not allergic to any of the ingredients.
  • It may not be feasible for those with kidney disease to take all types of antacids.
  • An antacid may interact with other medications.Talk to the doctor before taking an antacid.

Talk to the doctor before taking an antacid.

Folic Acid Update

By Dr K K Aggarwal
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  • Folic acid (vitamin B9) is a water-soluble B vitamin.
  • It is lost in traditional Indian cooking.
  • Folic acid is essential for DNA repair, cell division and normal cellular growth.
  • Profound deficiency of folic acid during pregnancy is associated with neural tube defects, such as spina bifida, in neonates.
  • Deficiency in adults has been associated with megaloblastic anemia and peripheral neuropathy.
  • In both men and women, low serum folate levels can increase homocysteine levels, which are correlated with elevated cardiovascular risk.
  • Low folic acid levels during pregnancy in women with epilepsy have been associated with fetal malformation and older enzyme-inducing anti-epileptic drugs (AEDs) are known to reduce serum folate levels.
  • The risk of having a pregnancy complicated by a major congenital malformation (e.g., neural tube defect) is doubled in epileptic women taking AEDs compared with those with a history of epilepsy not taking these agents.
  • Risk is tripled with AED polypharmacy, especially when valproic acid is included.
  • Consensus statements recommend 0.4-0.8 mg of folic acid per day in all women planning a pregnancy. Ideally, this should be started at least 1 month prior to pregnancy, if possible.
  • The guidelines recommend higher daily folic acid doses (4 mg/day) in women with a history of neural tube defects.
  • Enzyme-inducing anticonvulsants, such as phenytoin, carbamazepine, primidone and phenobarbital, are known to decrease folate levels, and valproic acid may interfere with folate metabolism.
  • Other AEDs, such as oxcarbazepine, lamotrigine and zonisamide, do not appear to alter folate levels.
  • Because many pregnancies are unplanned, it is recommended that folic acid supplementation be given routinely to all women of childbearing potential at 0.4 mg/day.