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Dr K K Aggarwal

FODMAPS free diet

By Dr K K Aggarwal
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Symptoms of irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) may be partly related to impaired absorption of carbohydrates. Fermentable oligo–, di– and monosaccharides and polyols (FODMAPs) in patients with IBS or IBD may reach the distal small bowel and colon where they are fermented, giving way to symptoms and increased intestinal permeability (and possibly inflammation).

Examples of FODMAPs include:

  • Fructans or inulins (wheat, onions, garlic, and artichokes)
  • Galactans (beans, lentils, legumes, cabbage, and Brussels’ sprouts)
  • Lactose (dairy)
  • Fructose (fruits, honey, high fructose corn syrup)
  • Sorbitol
  • Xylitol
  • Mannitol
  • Polyols (sweeteners containing sorbitol, mannitol, xylitol, maltitol, stone fruits such as avocado, apricots, cherries, nectarines, peaches, plums)

Avoidance of carbohydrates has been a popularized non-pharmacologic approach to reduce symptoms in IBS (and possibly modifying disease in IBD).

Food poisoning with rice dishes

By Dr K K Aggarwal
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  • Staphylococcus aureus and Bacillus cereus can cause acute food poisoning within 6 hours of ingestion of food. B. cereus is the likely cause when rice is the reason behind it.
  • B. cereus is able to persist in food processing environments on account of its ability to survive at extreme temperatures as well as its ability to form biofilms and spores.
  • B. cereus has been recovered from a wide range of foods, including rice, dairy products, spices, bean sprouts and other vegetables.
  • Fried rice is an important cause of emetic-type food poisoning linked with B. cereus.
  • The pathogen is found in uncooked rice, and heat-resistant spores have the potential to survive cooking.
  • Cooked rice subsequently at room temperature can allow vegetative forms to multiply, and the heat-stable toxin that is produced can survive brief heating.
  • B. cereus causes two types of toxin-mediated food poisoning -marked by either diarrhea or vomiting, based on the toxin involved. Vegetative cells produce the diarrheal toxin in the small intestine following the ingestion of either bacilli or spores. The emetic toxin is ingested directly from contaminated food. Both toxins can lead to disease within 24 hours of ingestion.
  • Heating can reduce the number of viable spores and vegetative bacteria that produce diarrheal toxin; however, spores associated with emetic toxin can survive heat.
  • The toxin cereulide has thermal stability and resists gastric conditions.
  • The ingested toxin can cause disease despite heating.
  • The emetic syndrome manifests as abdominal cramps, nausea, and vomiting. Diarrhea may also occur in about one-third of patients. Symptomsdevelop within 1 to 5 hours of ingestion, but can also develop within half an hour and up to six hours after ingestion of contaminated food.
  • Symptoms usually resolve in 6 to 24 hours.
  • Rice-based dishes are associated with emetic toxin-mediated disease. This could be attributed to cooling fried rice dishes overnight at room temperature and reheating them the next day.
  • Cereulide can cause symptoms at a dose of 8 to 10 micrograms per kilogram of body weight.

10 ways to keep the kidneys healthy

By Dr K K Aggarwal
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  1. Monitor blood pressure and cholesterol.
  2. Control weight.
  3. Dont overuse over-the-counter painkillers.
  4. Monitor blood glucose.
  5. Get an annual physical examination.
  6. Know if you have a family history of chronic kidney disease (CKD), diabetes or heart disease. If so, you may be at risk.
  7. Dont smoke.
  8. Exercise regularly.
  9. Follow a healthy diet.
  10. Get tested for chronic kidney disease if youre at risk.

HCFI tips to reduce your risk of NAFLD

By Dr K K Aggarwal
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  • Consume a healthy plant-based diet which is rich in fruits, vegetables, whole grains and healthy fats.
  • Overweight or obese individuals should limit the number of calories consumed in a day and exercise more. Those who have a healthy weight should work to maintain it by opting for a healthy diet and exercising.
  • Exercise most days of the week. One should try to get at least 30 minutes of physical activity every day.

Honey excellent for cough

By Dr K K Aggarwal
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A spoonful of honey can relieve night time cough in children and help them sleep better. In comparison with the cough syrup ingredient dextromethorphan or no treatment, honey seems better. According to a study published in the Archives of Paediatrics and Adolescent Medicine, the results are so strong that we can easily say that honey is better than no treatment and dextromethorphan is not.

There is no proven treatment effective for cough due to an upper respiratory infection like the common cold. Dextromethorphan is commonly used for cough but there is no evidence that it works and moreover, it carries some risks.

Honey is used across the globe as a home remedy for cough, and might provide a safe, effective alternative to cough medicine.

Investigators compared buckwheat honey, a honey-flavored dextromethorphan preparation, and no treatment in 105 children seeking treatment for night time cough due to cold. Children who received honey exhibited the greatest reduction in cough frequency and severity, and the most improved sleep, as did their parents. Its sweet, syrupy quality seems to soothe the throat. Its high antioxidant content could also be a beneficial factor. Honey also has antimicrobial properties.

Honey is; however, not recommended for infants below one year of age due to the risk of botulism spores.

Fever

By Dr K K Aggarwal
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Fever does not mean presence of infection. There are many situations where there may be fever without infection. Such fevers do not need antibiotics. 

  • Sepsis, a clinical syndrome, occurs due to the dysregulation of inflammatory response to an infection. The temperature is between 36°C to 38.30°C. Heart rate is often above 90 per minute.
  • Symptomatic inflammatory response syndrome (SIRS)is a clinical syndrome, which occurs as a result of dysregulated inflammatory response to any infections such as inflammation of the pancreas, inflammation of the vessels, clot formations in the veins.
  • Many antibiotics can cause fever; unless they are discontinued, fever will not subside.
  • Hyperthermia, a condition with elevated body temperature, is not called fever. Examples – exposure to heat or heat stroke and in response to anesthetic drugs and anti-psychotic drugs.
  • Hyperthermia may not respond to anti-fever drugs.
  • When fever is more than 41.5°C, it is called acute hyperpyrexia.
  • Hyperpyrexia is often seen in patients with severe infections but it may also occur in brain hemorrhage. It responds to anti-fever drugs.
  • High temperature without infection can be seen in case of a hyperfunctioning thyroid gland.
  • Recreational drugs such as Ecstasy may cause fever without any infection.
  • Mild fever can also occur following exertion.

Diagnosis of hypertension in childhood requires repeated BP

By Dr K K Aggarwal
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It is needed to confirm the presence of hypertension on the basis of three blood pressure measurements at separate clinical visits.

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.

A study published in the journal Pediatrics in 2013 noted that the initial BP measurement was normal (below the 90th percentile), pre–hypertensive (systolic or diastolic BP between the 90th or 95th percentile) and hypertensive (systolic or diastolic BP ≥95th percentile) in 82%, 13%, and 5% of children.

At follow–up, subsequent hypertensive measurements were noted in just 4% of the 10,848 children who had shown initial hypertensive values. The overall prevalence of hypertension in the cohort was 0.3%.

Diet is linked to the diabetes epidemic

By Dr K K Aggarwal
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A study published in the journal Diabetes Care highlights the importance of the whole diet rather than focusing on certain foods or food groups that might be beneficial.

A diet rich in whole grains, fruits and vegetables (leafy green), nuts and low-fat dairy may help people lower their risk of type 2 diabetes by 15% over 5 years than those who ate the lowest amounts of these foods.

In contrast, adults whose diets were high in red meat, high-fat dairy, refined grains like white bread plus beans and tomatoes, saw their diabetes risk go up by 18% as a group.

Type 2 diabetes is closely linked to obesity and it is well-known that maintaining a healthy weight through diet and exercise reduces the risk of developing the disease. Diet affects diabetes risk independent of a person’s weight.

Beware of fatty liver

By Dr K K Aggarwal
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  • Nonalcoholic fatty liver disease (NAFLD) refers to the presence of hepatic steatosis (fatty liver), when no other causes for secondary hepatic fat accumulation (heavy alcohol consumption) are present.
  • NAFLD, if not treated, may progress to cirrhosis and is a major cause of cryptogenic cirrhosis.
  • NAFLD is subdivided into: Nonalcoholic fatty liver (NAFL) or simple fatty liver with no liver inflammation and nonalcoholic steatohepatitis (NASH) or fatty liver with liver inflammation.
  • Patients with NAFLD may have mild or moderate increase in SGOT and SGPT levels (liver enzymes).
  • However, normal SGOT and SGPT levels do not rule out NAFLD.
  • When raised, SGOT and SGPT levels are usually 2 to 5 times the upper limit of normal.
  • In acute viral hepatitis, the SGOT/SGPT ratio is less than 1 (unlike alcoholic fatty liver disease, where the ratio is usually greater than 2).
  • The degree of SGOT and SGPT elevation does not point to the degree of liver inflammation or fibrosis. Additionally, normal SGOT, SGPT levels do not exclude clinically significant histologic injury.
  • Alkaline phosphatase may be raised to 2 to 3 times the upper limit of normal.
  • Serum albumin and bilirubin levels are often within the normal range, but they may be abnormal in patients with cirrhosis. When cirrhosis develops, the patient may have prolonged prothrombin time and cytopenias.
  • Serum ferritin greater than 1.5 times the upper limit of normal in patients with NAFLD may point to presence of inflammation.

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 coronary artery disease 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.

Chocolate, not tea, good for the heart

By Dr K K Aggarwal
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Regular intake of polyphenol-rich cocoa products, such as dark chocolate, may be considered a part of dietary approaches to lower blood pressure (BP); however, there should be no total gain in calorie intake.

Drug treatment is the basis of BP control, and it should be accompanied by lifestyle measures,including exercise and proper diet.

An occasional cup of cocoa can be taken but not chocolate milk, because it is high in sugar and fat.

A survey of medical literature noted that cocoa-rich products, and not tea, help reduce high BP. The survey covered 10 studies on cocoa, involving 173 participants, and five studies on tea with 343 participants. The cocoa studies lasted an average of two weeks, with four out of five trials reporting a reduction in both systolic and diastolic BP.

The average reduction was 4 to 5 mmHg in systolic pressure and 2 to 3 mmHg in diastolic pressure, which was sufficient to reduce the risk of stroke by 20% and of coronary heart disease by 10%. No such reduction in BP was noted in any of the studies involving tea, which continued for an average of four weeks. Tea and cocoa contain different kinds of polyphenols; while tea has flavan–3–ols, cocoa has procyanids.

Hepatitis A, E and typhoid are the hygiene markers of a city

By Dr K K Aggarwal
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It is diseases such as jaundice with hepatitis A in children and E in adults, typhoid, cholera and gastroenteritis that reflect the hygiene status of a city and not the occurrence of dengue and malaria.

Food- and water-borne diseases can be eradicated by the following public awareness formula: When in doubt follow the principle, “heat it, boil it, cook it, peel it or forget it”. This means that in an unhygienic environment, one can eat an orange or a banana but not a tomato or apple. Other steps are:

  • Do not eat salad that has been left open for more than 2 hours even if it is washed properly.
  • Do not consume cooked food that has been left on the table for more than 2 hours.
  • Vegetables grown under the ground or over the surface of the ground should be washed properly before eating them raw. They may be the biggest source of worm infection in the brain, a condition called neurocysticercosis.
  • Boiled water is the safest water to drink.
  • Ice made from unhygienic water can be the source of most water-borne diseases.

It is our duty to keep our home and city as clean as possible. We must regard our city as our extended home, a garden as our farmhouse and roads as our personal walking tracks.

What should you do if you don’t have soap and clean, running water?

By Dr K K Aggarwal
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Washing hands with soap and water is the best way to reduce the number of microbes present on them.

If soap and water are not available, one can use an alcohol-based hand sanitizer having at least 60% alcohol. Alcohol-based hand sanitizers have the ability to reduce the number of microbes on hands in certain situations, but they can’t eliminate all types of pathogens.

Shoe Hygiene

By Dr K K Aggarwal
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  • Avoid poorly fitting shoes.
  • Patients with diabetes should avoid walking bare feet.
  • Very tight shoes can cause pressure ulcers.
  • High heels can be worn occasionally, but if you wear them more often, it can lead to significant foot pain and other problems such as bunions, corns and calluses and more complex conditions like misshapen hammer toes or worsening excruciating pain in the ball of the foot.
  • Shoes that are tight and constrict the natural shape of the foot can cause foot pain.
  • Women, who regularly wear high heels, walk with shorter, more forceful strides and require more muscles to walk.
  • Shoes can be classified as:

o Good shoes or low risk shoes: athletic and casual sneakers.

o Average mid risk shoes: hard or rubber–soled shoes – special shoes and work boots.

o Poor or high risk shoes: ones that do not have support or structure such as high heels, sandals, sleepers.

  • Pointed toed shoes disrupt the natural shape of the feet.
  • If you like heels, choose the ones that are not higher than 2″ and are wide.
  • It is always better to buy shoes in the evening as the foot swells up by evening. If you buy them in the morning, the shoes may feel tight in evening hours.
  • Always try both the shoes while you buy them as one foot may be smaller or larger than the other one in some people.
  • Always buy the shoes that are wider than your foot, i.e., wider than broadest part of the foot.
  • The actual size of the shoe may vary from manufacturer to manufacturer.
  • Your foot tends to become longer and wider as you age. Therefore, always check the size of your shoes every two years.
  • Narrow shoes with heels should only be used for a function, dinner or a formal party, especially where you do not have to stand for a longer time.

Hospital safety incidents have 20% mortality

By Dr K K Aggarwal
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Patients who experience a patient safety incident have a 20% likelihood of dying as a result of the incident. The 16 different patient safety concerns include:

  1. Complications of anesthesia
  2. Death in low mortality diagnosis related groups
  3. Bed sores
  4. Failure to rescue
  5. Foreign body left in during procedure
  6. Physician-induced pneumothorax (air in the lungs)
  7. Selected infections due to medical care
  8. Postoperative hip fracture
  9. Postoperative hemorrhage or hematoma
  10. Postoperative physiologic and metabolic derangements
  11. Postoperative lung failure
  12. Postoperative pulmonary embolism or deep vein thrombosis
  13. Postoperative infections
  14. Postoperative wound dehiscence in abdominopelvic surgical patients
  15. Accidental puncture or laceration
  16. Transfusion reaction