Sunday, February 28, 2010

Coronary Heart Disease and Dietary Interventions

Dyslipidemia is the main biochemical feature of coronary heart disease (CHD). Dyslipidemia refers to the elevated level of total cholesterol (TC) as well as triglycerides (TG) or a decreased level of high density lipoprotein (HDL). Dyslipidemia may result from alteration in the production of lipid components or due to abnormal catabolism or clearance as a result of environmental or genetic factors. Single or multiple gene mutations affecting the triglycerides/low density lipoprotein cholesterol are the cause of primary dyslipidemia. Sedentary life style or excessive dietary intake of saturated fat, cholesterol and trans fats can cause secondary dyslipidemia. Secondary dyslipidemia may also be caused due to certain health ailments, such as: diabetes mellitus (DM), obesity, chronic kidney disease, hypothyroidism, primary biliary cirrhosis and cholestatic liver disease. Overuse of alcohol and some drugs can also cause secondary dyslipidemia. Early identification and treatment of children with primary dyslipidemia or hyperlipidemia is important to prevent coronary heart disease. Screening is recommended for children above the age of two having positive family history of premature coronary heart disease, early heart disease. Positive family history of CHD refers to the history of angina pectoris, peripheral vascular disease, myocardial infarction, cerebrocardiac disease, coronary atherosclerosis or sudden death before the age of 55 years in parents, grand parents or first degree uncle or aunt.

Fasting cholesterol and low density lipoprotein (LDL) levels should be determined in the sera of children suspected to have dyslipidemia. Total cholesterol level <170 mg/dl and LDL <110 mg/dl are considered normal, whereas total cholesterol level >200 mg/dl and LDL >130 mg/dl are considered elevated in children. Levels between upper and lower limits could be called borderline values. Physical activity in the form of exercise and brisk walking should be encouraged to maintain weight control and endurance in insulin resistance in diabetics to prevent the risk of developing cardiovascular disease.

Dietary interventions play a vital role in the management of dyslipidemia. A diet low in saturated fat and cholesterol, high in complex carbohydrates should be encouraged for the normal growth and maintenance of desirable weight. Dietary fibre intake should be increased as it helps in reducing the blood cholesterol levels. 'Whole wheat flour bread', corn fakes and barley sattu should be preferred in addition to leafy vegetables. Regular intake of diet containing phytosterols/stanols, omega-3 fatty acid and Soya protein have been found to be effective to reduce the serum LDL cholesterol as well lowering the total cholesterol. Pharmacological treatment is recommended for managing the dyslipidemia in children at 10 years of age and adolescents with LDL>190mg/dl.

Wednesday, February 24, 2010

Rickets: A preventable bone disease

Rickets is a well known bone disease seen among infants and children. It causes skeletal deformities and softening of bones. An identical disorder seen amongst adults is known as osteomalacia. Rickets is a vitamin deficiency disease caused by lack of vitamin-D. Dietary intake of vitamin-D and natural conversion of pro-vitamin-D to vitamin-D through ultraviolet radiation of sunlight is must for the prevention of rickets. Inadequate exposure to sunlight may be the main biological factor responsible for the development of rickets, but inadequate intake of vitamin-D and calcium remains the number one cause of rickets. So, the main factors responsible for causing rickets are malnutrition, vegetarianism and inadequate exposure to sunlight. Rickets is very common amongst the malnourished children. Egg yolk, butter and some species of fish are the best known natural sources of vitamin-D. Lactating mothers should always take adequate diet rich in vitamin-D to prevent rickets in their infants. Growing children need food supplements fortified with vitamin-D in addition to normal diet and adequate exposure to sunlight for healthy bones and prevention of rickets.

Geriatrics: Old age and its management

The definition of old age varies in indifferent zones of the worldwith respect to the cutoff age or the age of onset of old age. Arbitrarily the attainment of the age of 65 years is said to be the knocking point of old age, but the health status of all old people is always influenced by physical and emotional stress. As a general criterion , all people above the age of 75 fall in the category of old. Generally doing all the duties of personal cleanliness and comfort, unassisted is a challenge for some old people. Since 1950 Geriatric medicine has been recognized as a specialty of medicine which focuses on the healthcare of aged citizens. Geriatricians are better trained in the care of elderly patients than the general physicians. The old generally suffer from incapacitating illness. Very few hospitals have special wards for old and the specialty of geriatrics. Many people suffer a decline in their metabolic and immune functions when they get old. The health authorities of all the countries should have comprehensive policy for the care of old people. Our cultural traditions include the respect for parents and the old. The fifth commandment directs, "to honour thy father and mother". The specialized agencies of the U.N. (including I.L.O., F.A.O., U.N.E.S.C.O. and W.H.O.) and many non-governmental organizations (NGOs) have been doing their best for the general care and medicinal needs of the elderly. NGOs should focus their attention on the vital sectors like personal hygiene, food, optimal clothing, exercise and entertainment in an effort to provide quality life to the inmates of old age homes. The elderly people need our special attention as we do in case of children. There is a need for integration of the specialty of geriatrics with other medical and paramedical services in order to provide appropriate medical expertise to elderly patients.