HEALTH & FITNESS

Underweight babies: growth charts may be wrong
Rebecca Hardy

When a baby is born, everyone wants to know its weight. But my baby's size, or lack of it, was an issue for six months. She wasn't putting on enough weight, health visitors said. Other babies' growth charts climbed steadily, but not Alice's. In some weeks she put on just a few ounces, in others her weight leapt up.

Nuclear medicine for young hypertensive
Dr K.S. Soin

Mayhem, chaos, nuclear families, deadlines and multi-tasking by individuals have lead to a pronounced effect on our life-styles. The imaging modalities leading to the cause and effects of hypertension being elucidated are a maze and have to be understood for the consequences of the disease process.

Physical activity, diet can control gout
Dr Ravinder Chadha

Gout is a type of arthritis which occurs due to an increase in the uric acid level in the body. Uric acid is, in fact, a waste product which under normal circumstances is flushed out by the kidneys via urine. In the case of a rise in its level beyond the normal point, it then gets deposited in the joints in the form of crystals. This leads to inflammation of the joints causing pain, swelling, redness and tenderness.

Health Notes
Eating potatoes gives your immune system a boost

Washington: Eating potatoes is not only good for bowel health, but also for the whole immune system, especially when they come in the form of a potato salad or eaten cold.

  • Bone marrow stem cells may help enhance hearing recovery

  • Obesity may be sign of insulin therapy for Type 1 diabetes

  • Omega-3 fatty acids diet could protect from blindness

 

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Underweight babies: growth charts may be wrong
Rebecca Hardy

When a baby is born, everyone wants to know its weight. But my baby's size, or lack of it, was an issue for six months. She wasn't putting on enough weight, health visitors said. Other babies' growth charts climbed steadily, but not Alice's. In some weeks she put on just a few ounces, in others her weight leapt up.

For Alice and me, this hardly seemed a problem. I enjoyed breastfeeding and was blissfully happy. But the weighing clinic and those fortnightly interrogations did grind me down. Was I eating enough? Was the baby latched on? A health visitor suggested I give formula milk: "You want to see she's thriving," she said. Alice was tested for a urine infection (nothing). Then we had an emergency doctor's appointment (she was fine). But the nagging continued.

It's difficult to describe how undermining this is. Babies don't come with instruction manuals. From the moment they love-bomb your life, all crumpled faces and incomprehensible cries, you have an instinct to protect them. And to be told that you are failing as a mother to give them adequate food is demoralising and distressing. By week 18, I was so fed up that I decided to top her up with formula milk instead.

I didn't realise then that I was following a well-worn path for breast-feeding women. I started to hear whispers; the charts were "flawed", based on formula-fed babies, who tend to put on more weight than breast-fed ones (and not good weight). At first, I treated the rumours with caution, but the rumblings grew louder. One mother confessed to not taking her second baby to be weighed at all, she'd had such worry with her first.

So I looked into it, and guess what? Formula-fed babies are heavier; after the early weeks, they have higher intakes of energy compared to breast-fed babies' lower body temperature and lower metabolic rate (on average). And the chart standards Alice was failing to meet? Based on the growth of mainly formula-fed infants.

In 2005, the World Health Organisation said it would publish new growth charts, based on the optimum growth standards of breast-fed babies. "Formula-fed infants and breast-fed infants grow differently," said Dr Mercedes de Onis of the WHO. "The problem is that by these [current UK] charts, breast-fed babies seem to be growing poorly from as early as two to three months. But the problem is not that the baby is not growing well, it is that the standards do not reflect the growth of breast-fed infants."

— The Independent

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Nuclear medicine for young hypertensive
Dr K.S. Soin

Mayhem, chaos, nuclear families, deadlines and multi-tasking by individuals have lead to a pronounced effect on our life-styles.

The imaging modalities leading to the cause and effects of hypertension being elucidated are a maze and have to be understood for the consequences of the disease process.

They have been categorised into direct imaging modalities evaluating the effects of hypertension. About 80 per cent of hypertension is essential for which no cause can be determine. Out of these 20 per cent of patients, renal artery stenosis is a cause in 20 per cent of the patients with hypertension and a significant percentage of these are young hypertensive in their 20’s and 30’s. These require an aggressive diagnostic assessment and treatment.

The primary modalities for the patients with in this group are ultrasound with doppler; computed tomographic angiography, magnetic resonance angiography and conventional angiography.

Renal artery stenosis (the leading cause of hypertension in young hypertensive) is tricky. The degree of stenosis does not corroborate with the degree of hypertension; nor does it specifically mean that this is the cause for the patient’s hypertension.

Secondary hypertension due to the diseases of the renal artery, i.e. renovascular hypertension, is associated with 1-5 per cent of all cases of hypertension. Atherosclerosis and fibromuscular dysplasia are the commonest causes.

Detection of renal artery stenosis with multislice imaging by C.T. scan, magnetic resonance angiography and conventional angiographic techniques has reached its zenith.

However, whether these stenosed arteries are the cause for reno-vascular hypertension is most scientifically deciphered by nuclear medicine studies termed as DTPA (Di-ethylene tetra-amine penta-acetic acid) renogram with captopril challenge.

Besides establishing the reno-arterial stenosis, it establishes the functional status of the kidney. The drop in functions on the usage of captopril points to the presence of renal artery stenosis, establishing the cause and effect of renal artery stenosis and hypertension.

However, hypertension, being the most lethal silent killer, has an interplay with all organs like the heart, brain, eyes, leg vessels, etc, thus making simple conclusions a distant reality.

A simple and safe physiological test for assessing the renovascular etiology of hypertension is an established DTPA renogram with captopril challenge, which gives both an indication of the renal artery status and the functional status of the kidney.

Moral of the nuclear medicine story:

In a young hypertensive, it is imperative to assess the renal arterial status and functional ability in a planned pharmacologically controlled study and that makes a combination of ultrasound study with doppler profile and DTPA renogram with captopril challenge, almost a complete diagnostic armamentarium.

The writer is a diagnostic specialist based in Ludhiana.

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Physical activity, diet can control gout
Dr Ravinder Chadha

Gout is a type of arthritis which occurs due to an increase in the uric acid level in the body. Uric acid is, in fact, a waste product which under normal circumstances is flushed out by the kidneys via urine. In the case of a rise in its level beyond the normal point, it then gets deposited in the joints in the form of crystals. This leads to inflammation of the joints causing pain, swelling, redness and tenderness. The big toe is affected the most while the ankle, knee, feet, hands, wrist and elbows could also share the brunt.

Gout is predominantly a disease which afflicts men over the age of 40 with a high standard of living. Women rarely develop gout prior to attaining menopause and more often beyond the age of 60. Diagnosis is derived via blood tests and 24 hours’ urine which reveals abnormally high levels of uric acid.

Symptoms: The onset is usually acute and unprecedented. Typically, an individual is awakened by acute, agonising pain in the big toe during night-time.

The skin over the joint becomes hot, red and swollen, with a feeling of pressure around the affected area. The intensity of pain is so severe that even a light-weight bed-sheet cannot be kept over the joint. Wearing of footwear is often impossible.

In the majority of gout attacks, a single joint is involved and with treatment it gets resolved within 5 to 10 days. Usually the recurrence is within a year.

In other cases, the gout becomes chronic with attacks occurring frequently. The crystals of uric acid are deposited inside the joint and in the surrounding tissues and termed as “tophi”. The end result is destruction of the joint.

Precaution regarding diet:

Control of total calorie intake with special precaution regarding foods and drinks which produce excessive uric acid should be avoided. To keep uric acid low, one should avoid the following:

  • Tea, coffee and chocolate.
  • Animal proteins like seafood, liver and meat extracts etc.
  • Vegetables like peas, beans, spinach and lentils.
  • Alcohol in any form, beer, wine, etc.
  • Certain medication like diuretics (also known to water pills), particularly those used to treat high blood pressure, can set off a gout attack.
  • Drugs that raise uric acid levels (e.g. aspirin)

Treatment: The aim of treatment is to provide relief from acute attacks, and prevent further attacks and damage to the joints. Certain medications reduce the pain, swelling and stiffness of the joints. They do not, however, prevent further joint damage. Taking more than one pain-relieving medicine at a time increases the possibility of side-effects such as heart burn, ulcers and bleeding.

Allopurinol (Zyloric) is used on a long-term basis, and sudden stopping and starting this medicine could trigger a gout attack.

Steroid injections into the joint are given for immediate relief from pain and swelling.

Exercise: Certain exercises help reduce uric acid levels and prevent gout although they could not do much during an attack. Never exercise during inflamed joints as this could further worsen the condition by causing more pain and prolonged inflammation. Initiate exercises only when inflammation subsides.

The exercises to increase the range of motion (ankle and great toe). These help make joints flexible and mobile and reduce stiffness e.g. rotation of ankle in a circular motion:

  • Keeping knees partially flexed try drawing the alphabet in space leading with the toes but moving at the ankle.
  • On a chair or low mat table with the feet on the floor. Place a number of small objects such as marbles or piece of cloth to one side of the involved foot. Pick up one object at a time by curling the toes around it and placing on the other side of the foot.

Strengthening exercises increase and/ or maintain the strength of the muscles. They are usually performed using weights or with stretch bands, e.g. long sitting with a towel or stretch band under forefoot, pulling the foot towards the body.

Relaxation: Relaxing muscles around an inflamed joint reduces pain. Try meditation, deep breathing exercises; listen to music or relaxation tapes.

People suffering from gout can decrease or discontinue medication by changing their lifestyle.

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Health Notes

Eating potatoes gives your immune system a boost

Washington: Eating potatoes is not only good for bowel health, but also for the whole immune system, especially when they come in the form of a potato salad or eaten cold.

In a study on an animal model, researchers in Spain found that pigs fed large quantities of raw potato starch (RPS) not only had a healthier bowel, but also decreased levels of white blood cells, such as leucocytes and lymphocytes in their blood.

White blood cells are produced as a result of inflammation or disease, generally when the body is challenged.

The general down-regulation of leucocytes observed by the Spanish researchers suggests an overall beneficial effect, a generally more healthy body. — ANI

Bone marrow stem cells may help enhance hearing recovery

Washington: A study of mice conducted by Japanese researchers has shown that a therapy with bone marrow stem cells has the potential to enhance hearing recovery after partial loss.

Published in The American Journal of Pathology, the study found that “Mesenchymal stem cell transplantation accelerates hearing recovery through the repair of injured cochlear fibrocytes.”

Led by Dr. Tatsuo Matsunaga of National Tokyo Medical Center, the researchers induced acute hearing loss in rats by destroying cochlear fibrocytes with the help of drugs. — ANI

Obesity may be sign of insulin therapy for Type 1 diabetes

Washington: Researchers at the University of Pittsburgh Schools of the Health Sciences studying links between an early sign of heart disease called coronary artery calcification and body fat have found that more fat may have some advantages, at least for people, particularly women, who have type 1 diabetes.

Cardiovascular complications, including heart disease, are a leading cause of death for people with diabetes, who tend to suffer cardiovascular disease decades earlier than non-diabetics.

“Gaining weight may reflect good or better treatment with insulin therapy, which may partly explain why participants who gained weight over time had lower mortality rates,” said Trevor Orchard, professor of epidemiology at the University of Pittsburgh Graduate School of Public Health (GSPH). — ANI

Omega-3 fatty acids diet could protect from blindness

Washington: A recent study, conducted on mice has found that Omega-3 polyunsaturated fatty acids could protect against the growth and progression of retinopathy, a deterioration of the retina, which often leads to blindness.

The study, a combined effort by researchers at Children’s Hospital Boston, the primary pediatric teaching affiliate of Harvard Medical School, Brigham and Women’s Hospital, Massachusetts General Hospital, the University of Goteborg in Sweden, and the National Eye Institute (NEI) and National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health (NIH), is published in the July 2007 issue of the journal Nature Medicine. — ANI

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