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Dr K K Aggarwal

Tips to prevent anemia from becoming severe during pregnancy

By Dr K K Aggarwal
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  1. Eat iron-rich foods such as meat, chicken, fish, eggs, dried beans and fortified grains. The form of iron in meat products, called heme, is more easily absorbed than the iron in vegetables. If you are anemic and you ordinarily eat meat, increasing the amount of meat you consume is the easiest way to increase the iron your body receives.
  2. Eat foods high in folic acid, such as dried beans, dark green leafy vegetables, wheat germ and orange juice.
  3. Eat vitamin C-rich foods such as citrus fruits and fresh, raw vegetables.
  4. Cook in cast iron pots as this can add up to 80% more iron to your food.
  5. Take your prenatal multivitamin and mineral pill which contains extra folate.

Dentists can diagnose

By Dr K K Aggarwal
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  1. Early mouth cancer
  2. Scurvy: In the mouth, scurvy can cause gums to swell, bleed and soften which can lead to tooth loss.
  3. Eating disorder: regular bouts of vomiting covers the teeth in strong gastric acid from the stomach that can wear down the tooths protective layer of enamel, causing teeth to become discolored, cracked and sensitive.
  4. Anemia: Ulcers at the corner of the mouth. A change in color of the gums and tongue
  5. Sinus infection: Infected sinuses can cause pain in the jaw and around the teeth, which can be mistaken for a toothache.
  6. Vitamin D is needed to absorb calcium which helps to prevent tooth decay and gum disease.
  7. Too little zinc can leave you open to gum disease, dry mouth and loss of sensation in your tongue.
  8. Low levels of vitamin B3, or niacin, can cause the tip of the tongue to become red and swollen
  9. Vitamin B2 – without it your tongue can become sore and your lips, red and shiny.
  10. B12 levels which can prevent bad breath, loss of taste and a fissured tongue.
  11. Diabetics are at a higher risk of early gum disease – gingivitis – and serious gum disease – periodontitis.
  12. Biting your nails: If you like a nibble, you are putting undue stress on your teeth, causing them to crack, chip and wear down.

Jaw pain, recessed gums and even headaches are other side effects caused by the grinding and clenching involved in nail biting, as well as the germs being passed into your mouth every time you feel like a nibble.

Tips to prevent anemia from becoming severe during pregnancy

By Dr K K Aggarwal
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  1. Eat iron-rich foods such as meat, chicken, fish, eggs, dried beans and fortified grains. The form of iron in meat products, called heme, is more easily absorbed than the iron in vegetables. If you are anemic and you ordinarily eat meat, increasing the amount of meat you consume is the easiest way to increase the iron your body receives.
  2. Eat foods high in folic acid, such as dried beans, dark green leafy vegetables, wheat germ and orange juice.
  3. Eat vitamin C-rich foods such as citrus fruits and fresh, raw vegetables.
  4. Cook in cast iron pots as this can add up to 80% more iron to your food.
  5. Take your prenatal multivitamin and mineral pill which contains extra folate.

Some tips to prevent anemia

By Dr K K Aggarwal
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  1. Eat foods rich in iron. Some iron-rich foods include dark-green leafy vegetables, such as watercress and curly kale, iron-fortified cereals, whole grains, such as brown rice, beans, nuts, meat, apricots, prunes, and raisins.
  2. Include vitamin C-rich foods and drinks in your diet as it will help the body in absorbing iron.
  3. Avoid drinking tea or coffee with meals, as this affects the absorption of iron.
  4. Include enough sources of vitamin B12 and folic acid in your diet.

Besan or gram flour has health benefits

By Dr K K Aggarwal
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If you are in doubt that your food may be the cause of your illness try substituting one food each day. To begin with its best to use besan gram flour in place of wheat flour. People suffering from celiac disease cannot digest a protein called gluten which is found in barley and wheat flour. Gluten triggers immune system in patients to damage small intestine villi. As a result patients cannot absorb nutrients from food and remain malnourished which could lead to anemia weight loss and fatigue. Celiac disease patients suffer from fat malabsorption. A gluten free diet is also recommended for patients with wheat allergy dermatitis herpetiformis multiple sclerosis autoimmune disorders autism spectrum disorders ADHD and some behavioral problems. Gluten containing cereals are wheat barley rye oats and triticale. Gluten is also present as a food additive in the form of a flavoring stabilizing or thickening agent. In these conditions one should switch over to gluten free foods. The best alternative is to shift from wheat flour to gram flour besan .

Defining Acute MI

By Dr K K Aggarwal
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  • In 1979: The diagnosis of acute MI was based on WHO criteria based on epidemiology
  • In 2000: A Joint committee of European Society of Cardiology (ESC) and American College of Cardiology (ACC) proposed a clinically based definition of an acute, evolving, or recent MI.
  • In 2007: Joint Task Force of the European Society of Cardiology, American College of Cardiology Foundation, the American Heart Association, and the World Health Federation (ESC/ACCF/AHA/WHF) refined the 2000 criteria and defined acute MI as a clinical event consequent to the death of cardiac myocytes (myocardial necrosis) that is caused by ischemia (as opposed to other etiologies such as myocarditis or trauma)
  • 2012: This definition was not fundamentally changed in the third universal definition of MI released in 2012 by the ESC/ACCF/AHA/WHF.

Third universal definition

Any one of the following criteria meets the diagnosis of MI:

  1. Detection of a rise and/or fall of cardiac biomarker values (cTn with at least one value above the 99th percentile upper reference limit (URL)) and with at least one of the following:
    • Symptoms of ischemia
    • Development of pathologic Q waves in the ECG
    • New or presumed new significant ST–segment–T wave (ST–T) changes
    • New LBBB
    • Identification of an intracoronary thrombus by angiography or autopsy
    • Imaging evidence of new loss of viable myocardium or a new regional wall motion abnormality.
  2. Cardiac death with symptoms suggestive of myocardial ischemia and presumed new ischemia ECG changes or new LBBB, but death occurred before cardiac biomarkers were obtained, or before cardiac biomarker values would be increased.
  3. PCI- related MI: elevation of cTn >5 × 99th percentile upper reference limit in patients with normal baseline values or a rise of values >20 percent if the baseline values are elevated and are stable or falling. In addition, either (i) symptoms suggestive of myocardial ischemia, or (ii) new ischemic ECG changes or new LBBB, or (iii) angiographic loss of patency of a major coronary artery or a side branch or persistent slow– or no–flow or embolization, or (iv) imaging demonstration of new loss of viable myocardium or new regional wall motion abnormality are required.
  4. Stent thrombosis associated with MI: Detected by coronary angiography or autopsy in the setting of myocardial ischemia and with a rise and/or fall of cardiac biomarkers with at least one value above the 99th percentile
  5. CABG–associated MI: Elevation of cardiac biomarker values >10 × 99th percentile URL in patients with normal baseline cTn values. In addition, either (i) new pathologic Q waves or new LBBB, or (ii) angiographic documented new graft of native coronary artery occlusion, or (iii) imaging evidence of new loss of viable myocardium or new regional wall motion abnormality.

The joint task force further refined the definition of MI

  • Type 1 (spontaneous MI): MI consequent to a pathologic process in the wall of the coronary artery (e.g., plaque erosion/rupture, fissuring, or dissection), resulting in intra luminal thrombus
  • Type 2 (MI secondary to an ischemic imbalance): MI consequent to increased oxygen demand or decreased supply (e.g., coronary endothelial dysfunction, coronary artery spasm, coronary artery embolus, anemia, tachy–/bradyarrhythmias, anemia, respiratory failure, hypertension or hypotension)
  • Type 3 (MI resulting in death when biomarker values are unavailable): Sudden unexpected cardiac death before blood samples for biomarkers could be drawn or before their appearance in the blood
  • Type 4a (MI related to PCI)
  • Type 4b (MI related to stent thrombosis)
  • Type 5 (MI related to CABG)

Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Circulation 2012;126(16):2020–35.