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Dr K K Aggarwal

If you have high BP, keep your sugar lower than 90

By Dr K K Aggarwal
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Hypertension is a risk factor for type 2 diabetes. If not properly managed they are likely to end up with diabetes with subsequent high risk of kidney damage.

The results of the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) study have shown that the major predictor of new-onset diabetes (NOD) in patients with hypertension is high baseline fasting plasma glucose levels of more than 90mg/dL. The risk increases by 5.8 times for each 18mg/dl rise above 90 mg/dL.

Other risk factors are higher weight, higher blood pressure and higher triglyceride levels. Hypertensive patients on atenolol (beta blocker drug) with or without a diuretic are also at risk.

On the other hand, high BP patients on amlodipine (calcium blocker) ± perindopril (ACE inhibitor), with high good HDL cholesterol levels, moderate alcohol use and age older than 55 years are protected from developing diabetes.

Reduce weight first if facing infertility problem

By Dr K K Aggarwal
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the first step can bring back their fertility.

Obese men are more than three times as likely to have low sperm counts compared with their normal-weight peers. A study published in the journal Fertility and Sterility showed that the heaviest men were at 3-fold increased risk of having a low count of progressively motile sperms, those that swim forward in a straight line.

  1. Increased body fat can also contribute to lower testosterone levels and higher estrogen levels.
  2. Obese men were also 1.6 times more likely than overweight or normal-weight men to have a high percentage of abnormally shaped sperm.
  3. There is a trend toward increasing likelihood of erectile dysfunction with increasing BMI.
  4. Obesity is associated with a greater risk of impotence.
  5. Obesity is also associated with metabolic syndrome and polycystic ovarian disease (PCOD) in women and associated infertility.

Some measurement mistakes that can lead to high BP

By Dr K K Aggarwal
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  1. Having a full bladder – This can add 10-15 points to your reading. You should always empty your bladder before measuring blood pressure.
  2. Slouching, unsupported back/feet – Poor support when sitting can increase your reading by 6-10points. Make sure you’re in a chair with your back supported and feet flat on the floor or a footstool.
  3. Unsupported arm – If your arm is hanging by your side or you have to hold it up during a reading, you may see numbers up to 10 points higher than they should be. Position your arm on a chair or counter, so that the measurement cuff is level with your heart.
  4. Wrapping the cuff over clothing – This common error can add 5-50 points to your reading. Instead, be sure the cuff is placed on a bare arm.
  5. When the cuff is too small – Your pressure may read 2-10 points higher. Ensure a proper fit. Your healthcare provider can help you with this.
  6. Sitting with crossed legs – While polite, it could increase a blood pressure reading 2-8 points. It’s best to uncross your legs as well as ensure your feet are supported.
  7. Talking – Answering questions, talking on the phone, etc. can add 10 points. Stay still and silent to ensure an accurate measurement.

Tips to clinically differentiate between different types of fever

By Dr K K Aggarwal
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  • If a patient comes with fever with chills and rigors, think of Malaria in north and filaria in Vidarbha region in India.
  • In malaria, chills are in the afternoon; in filaria, the chills occur in the evening.
  • Fever with joint pains on extension often is due to Chikungunya (flexion improves the pain)
  • Think of dengue if there is fever with itching, rash and periorbital pain.
  • In fever with single chills, think of pneumonia.
  • Fever with sore throat, no cough, no nasal discharge: Think of streptococcal sore throat, especially in the children.
  • Fever with red angry–looking throat: Think of streptococcal sore throat
  • Fever with red epiglottis: Think of Hemophilus infection
  • Fever with cough and or nasal discharge: Think of common flu
  • Fever with cough, nasal discharge, nausea and vomiting: Think of H1N1 flu
  • Fever with toxic look, persistent fever: Look for typhoid
  • Fever with no or low rise in pulse: Look for typhoid
  • Fever with urinary symptoms (burning, frequency): Rule out urinary infection.
  • Fever with high TLC (white cell count) and liver pain: Rule out liver abscess
  • Fever with watery diarrhea, with no blood or mucous: Rule out acute gastroenteritis
  • After the fever is over, jaundice appears: This is viral hepatitis
  • After the fever is over, one feels very weak: Rule our dengue hemorrhagic fever.