HEALTH & FITNESS

Heart attack: the warning signs
The heart is the hardest working organ of human body, continuously pumping blood enriched with oxygen and vital nutrients through a network of arteries. It pumps about 5 litres of blood per minute, and this gets multiplied 10 times during peak exercise. To perform this arduous task, the heart muscle itself requires a good supply of oxygen-rich blood which is provided by a network of coronary arteries — left anterior descending (LAD), left circumflex (LCA) arising from the left side and right coronary artery (RCA) from the right side.

Avoid braces with early intervention
Human are provided with two sets of teeth. The initial teeth are popularly called “milk teeth set”. These consist of 20 teeth, 10 in each jaw. Nature has provided this set with fewer teeth than the permanent one in order to accommodate them into the smaller jaw of a child.

New urine test detects a common cause of kidney transplant failure
US researchers develop a novel noninvasive screen that could improve diagnosis and care of patients with Polyomavirus Nephropathy. A new and simple urine test can detect polyomavirus nephropathy, a relatively new and serious complication affecting up to 9% of kidney transplant recipients, according to a study appearing in the February 2009 issue of the Journal of the American Society of Nephrology (JASN).

Ayurveda and You
Aloe Vera: use it with care
Called Ghrit Kumari or Kumari in Sanskrit, Aloe has been considered a healing herb in ayurveda. Before the invasion of the western ornamental plants, Aloe was fondly grown in small pots in most of the Indian homes. On cutting the leaf of the plant, the sticky and smelly medicinal pulp present in it gives a shining and transparent appearance.

A common cause of low back pain
Low back pain can be due to prolapsed disc but pain on the sides of the spine can be due to sacroilitis — i.e. inflammation of sacroiliac joint. Sacroiliac joint connects the spine to the pelvis. The stability of the joint is due to the support of ligaments; hence the degree of movement is limited.

Health Notes

Drinking coffee may reduce stroke risk among women
Soon, just a drop of  blood to spot cancer
Weight-loss surgery cuts  diabetes risk, improves fertility

 

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Heart attack: the warning signs
Dr T.P. Singh

The heart is the hardest working organ of human body, continuously pumping blood enriched with oxygen and vital nutrients through a network of arteries. It pumps about 5 litres of blood per minute, and this gets multiplied 10 times during peak exercise. To perform this arduous task, the heart muscle itself requires a good supply of oxygen-rich blood which is provided by a network of coronary arteries — left anterior descending (LAD), left circumflex (LCA) arising from the left side and right coronary artery (RCA) from the right side.

If blood flow to the heart muscle is interrupted or blocked it suffers injury, called myocardial infarction and commonly known as heart attack.

Coronary artery disease is said to be present when plaque, an atherosclerotic chunk of fatty deposits, starts accumulating on the walls of coronary arteries, causing their hardening and narrowing. There is progressive narrowing of coronary arteries, thus starving heart muscle and rendering it ischaemic leading to chest pain called angina. Angina means coronaries are unable to supply adequate amount of blood to the heart muscle as is required by it.

The plaque can also rupture anytime, causing sudden occlusion of coronary artery by the formation of thrombus or blood clot. This sudden occlusion totally stops the blood supply to the heart muscle, leading to heart attack or myocardial infarction.

Anginal syndromes

Angina is the primary symptom of heart disease and heart attack. It is usually referred to as one of the two states: stable and unstable.

Stable angina is an extremely painful situation, a more predictable course and less serious than unstable angina. It is usually relieved by rest and responds well to medical treatment, especially with tablets kept below the tongue. Any event that increases oxygen demand can cause an anginal attack. Some typical triggers include exercise, cold weather, emotional tension and heavy meals.

Unstable angina is usually described as part of a condition called acute coronary syndrome (ACS). It includes patients with the condition called NSTEMI (non-ST-segment elevation myocardial infarction), also referred to non-Q-wave heart attack. In this, ECG and blood tests suggest a developing heart attack. These conditions are less severe than heart attack but may develop into full-blown heart attacks without aggressive treatment.

Anginal attacks can occur at anytime during the day, but a high proportion seems to take place in the early hours of the day. The unstable angina is often an intermediate stage between stable angina and a heart attack and its course is unpredictable, a sign of more serious disease. It is usually diagnosed if one or more of following conditions occur.

Pain awakens the patient or occurs at rest.

A patient who has never experienced angina but is now having severe or moderate pain during mild exertion within last two months.

Stable angina has progressed in severity, frequency and duration or medications are less effective in relieving pain.

Indicators of heart attack

Anyone who believes that he or she is having heart attack should not hesitate to contact emergency medical services.

People having any unusual chest pain or unexplained shortness of breath not clearing up with routine medications should go to a cardiologist immediately.

The severity of pain and other symptoms before heart attack vary greatly among individuals and the onset may be abrupt, gradual or intermittent.

Chest pain is the most common indicator and clinical expression of heart disease. People with risk factors for heart disease or having heart disease should be very particular about any chest pain. It may be experienced as crushing weight against chest with profuse sweating, may radiate to the left shoulder, arm, neck or jaw. Some may have a sense of fullness, squeezing or pressure over the chest. People may also experience nausea, vomiting, cold sweats, indigestion, heart-burn, abdominal pain and fainting. Many patients may not have chest pain, and may present with shortness of breath and cardiac arrest.

Some people with severe coronary artery disease may not experience angina — this condition is called silent ischaemia. It may be due to abnormal processing of heart pain by the brain. It is a dangerous condition because the patient has no warning signs of heart disease. It may occur mainly in diabetics.

Symptoms that is less likely to indicate a heart attack

Sharp pain brought on by respiration/coughing.

Pain mainly in lower or middle abdomen.

Pain is pin-pointed with tip of one finger

Pain reproduced by moving or pressing on chest wall/ arms.

Very brief pain lasting a few seconds.

Risk factors

There are many risk factors which can accelerate the process of coronary artery disease. These are smoking, diabetes, high blood pressure, high cholesterol, obesity and family history of premature heart disease.

The minor risk factors can be high stress jobs, type-A personalities and sedentary lifestyles. The risks which can be fully aborted by us alone are smoking and sedentary lifestyle.

Actions that need to be taken on the onset of symptoms

Chew a tablet of aspirin. Take nitroglycerin as spray or sublingual tablet and repeat after five minutes, maximum up to three doses. Immediately call or reach emergency services. Do not deceive yourself.

The writer is Consultant Cardiologist, Prime Heart and Vascular Institute, Mohali

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Avoid braces with early intervention
Dr H.S. Chawla

Human are provided with two sets of teeth. The initial teeth are popularly called “milk teeth set”. These consist of 20 teeth, 10 in each jaw. Nature has provided this set with fewer teeth than the permanent one in order to accommodate them into the smaller jaw of a child.

The 20-milk-teeth set gets completed by the age of two and a half years. By six years of age, as the jaw size increases, permanent teeth start cutting into the mouth.

Underneath the milk teeth lie juvenile /developing permanent teeth. As the permanent teeth mature and grow, they exert pressure on the roots of the milk teeth. The roots little by little get resorbed. Gradually, all the milk teeth fall off and are replaced by their permanent successors. In addition to the 20 permanent teeth which replace the milk teeth, six extra teeth in each jaw erupt into the mouth, three on each side of the jaw.

How early guidance helps prevent crooked teeth?

A few examples will elucidate this.

One: Due to certain reasons, sometimes the lower permanent teeth — incisors — may cut behind the lower anterior milk teeth. This gives the impression of a double row of teeth. In fact, the milk teeth have not yet shed. Here timely action is needed to extract the over-retained milk teeth. Once this is done, space is vacated for wrongly-erupting permanent incisors, and their placement can be brought to regular alignment without braces.

Two: Sometimes when jaw growth lags behind and permanent front teeth, which are naturally wider, start erupting, these teeth that cut into the mouth are crowded. This is like four people trying to sit on the rear seat of a small car. The jaw is not wide enough to accommodate the wider permanent teeth. They would naturally assemble in a crowded manner. This overcrowding can be checked again at this stage by a simple procedure called “serial extraction”. This can be carried out if the child is taken for consultation at an early stage eruption of permanent teeth.

Three: It is not uncommon to find one, two or more permanent teeth genetically missing in some individuals. Finally, when all the permanent teeth erupt, there will be vacant spaces at their positions. At an adult age, the empty spaces with no teeth would require replacement with a denture, a bridge or an implant.

If an early diagnosis of missing tooth/teeth is made, the empty spaces can be filled with the natural teeth with orthodontic movements of the adjoining teeth into this space. This would save the child from a lifetime of wearing dentures for the missing tooth/teeth. Similarly, supernumerary teeth can be taken care of if the child is taken for early intervention.

Similarly, retracted, retruded, or extruded chins should be taken care of at a younger age. The same goes for rotated, bigger and smaller-sized teeth, those with an altered shape and size and also the teeth with spacing.

Fourth: One of the causes of crooked teeth is the presence of oral habits like thumb sucking, digital sucking, tongue thrusting, nail biting and mouth breathing. This needs special attention by a specialist.

It is a misconception to wait for the child to grow and see all permanent teeth erupt before seeking treatment for crooked teeth.

The writer is former Professor and Head, Department of Oral Sciences, PGI, Chandigarh.

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New urine test detects a common cause of kidney transplant failure

US researchers develop a novel noninvasive screen that could improve diagnosis and care of patients with Polyomavirus Nephropathy. A new and simple urine test can detect polyomavirus nephropathy, a relatively new and serious complication affecting up to 9% of kidney transplant recipients, according to a study appearing in the February 2009 issue of the Journal of the American Society of Nephrology (JASN).

This advance could lead to better and early diagnosis and treatment of afflicted patients. While polyomaviruses are normally occurring viruses that harmlessly infect many adults, they pose serious health problems for immunocompromised individuals such as kidney transplant recipients who must take immunosuppressive medications to prevent organ rejection. 

Some of these patients develop a damaging infection called polyomavirus nephropathy that can lead to chronic kidney failure requiring either re-initiation of dialysis or another transplant.

Because no effective therapies to treat polyomavirus nephropathy exist, an early diagnosis is critical before it becomes serious. Therapy normally consists of lowering the dose of immunosuppressive drugs hoping for natural viral clearance. Currently there is no definitive way to accurately diagnose polyomavirus nephropathy. Physicians rely mostly on invasive and expensive kidney biopsies that can sometimes give false negative results.

Harsharan Kaur Singh of The University of North Carolina, Chapel Hill, North Carolina, USA (lead author) and her colleagues have now discovered a new and noninvasive method for highly accurate early diagnosis of this condition. The test qualitatively evaluates for the presence of “Haufen”— (of german origin meaning stack or pile)—in the urine.

Haufen are tightly clustered three-dimensional cast-like viral aggregates that form within the kidneys in patients with polyomavirus nephropathy and are excreted into the urine. Testing for Haufen is fast (three hours) and can be performed with current laboratory equipment in any electron microscopy facility. The technique utilized and adapted by the researchers is well established in virology and has been in routine use for over 40 years.

In their investigation, Drs Singh and Nickeleit found Haufen in urine samples from all 21 patients with early or late stages of polyomavirus nephropathy, but not in any of the 139 control patients without the condition. According to them, the new test could help physicians identify and monitor patients with polyomavirus nephropathy and could guide in the design of new therapeutic strategies. 

“An early and accurate diagnosis of polyomavirus nephropathy will result in a better understanding of the disease and ultimately improve treatment. Our diagnostic test is unique and could have a far reaching clinical impact,” they added.

While their findings are promising, the authors stress the need for additional studies, in particular-large prospective clinical trials-to further verify the test’s noted predictive potential before it becomes available for widespread use in patients with suspected polyomavirus nephropathy. One such trial is currently underway at The University of North Carolina. — Reuters

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Ayurveda and You
Aloe Vera: use it with care
Dr R. Vatsyayan

Called Ghrit Kumari or Kumari in Sanskrit, Aloe has been considered a healing herb in ayurveda. Before the invasion of the western ornamental plants, Aloe was fondly grown in small pots in most of the Indian homes. On cutting the leaf of the plant, the sticky and smelly medicinal pulp present in it gives a shining and transparent appearance.

Bitter and sweet in taste, Aloe has been described as cold, unctuous and heavy in its properties. According to ayurvedic beliefs, Aloe alleviates kapha and pitta and has been classified as bhedniya (accumulation breaking herb), netrarogaghna (alleviating ophthalmic diseases) and pleeharogaghna (ameliorating spleen diseases). 

According to the research conducted by the Central Council for Research in Ayurveda and Sidha (CCRAS), Aloe is antioxidant, anti-inflammatory, diuretic, anti-ulcerogenic, liver protective, digestive, antispasmodic and blood pressure lowering agent.

Ancient ayurvedic texts also describe Aloe to be useful in dyspepsia, colic, constipation, burns, dysmenorrhoea, abdominal tumours, obesity, sciatica-lumbago syndrome and joint pains. Due to the presence of certain enzymes and nutrients Aloe has a positive cosmetic value. Experimental studies have confirmed its anti-bacterial, anti-fungal and wound-healing properties.

Aloe can be best used as fresh gel extracted from the plant. To remove its stickiness and pungent smell, the gel should be washed in salt mixed warm water. Taking 10 gm of Aloe gel with ½ gm of turmeric powder once a day gives all of its therapeutic effects. 

Making a dish of fresh Aloe gel by roasting it in a small quantity of desi ghee and taking it once or twice a week with meals is a common practice in the rural areas of northern and central India.

Though the dose of fresh Aloe juice is 10 to 20 ml once or twice a day, its dried extract called “musabbar”, a favourite of Unani physicians, can be taken up to 300 mg in divided doses. For minor burns and scalds, Aloe should be immediately cut and squeezed on the affected parts. 

Its application also benefits the patients of blemishes resulting from multiple reasons. Used one week before the due date of menses, Aloe is a good remedy for painful and delayed periods.

Despite its so many therapeutic benefits, prolonged, unmonitored and overuse of Aloe may not only lessen its laxative action but can also severely impair electrolyte balance by reducing potassium thus disturbing cardiac rhythm in heart patients. 

Larger doses lead to the accumulation of blood in pelvic region and reflux stimulation of uterine muscles may bring about abortion or premature birth in late pregnancy. Aloe Vera’s active principles generally appear in milk during lactation. Due to these reasons Aloe is contraindicated in pregnancy, lactation, kidney complaints and irritable bowel conditions.

Over the past two decades, we have seen growing interest in natural and organic products. The recent no-hold-barred promotion of Aloe Vera by pharmaceutical companies gives the impression that crass commercialisation has definitely overshadowed the principle of adopting certain checks and balances associated with the use of herbal medicines. 

Ayurveda believes that the same drug, depending upon the method of its use, can act as a poison or a nectar. Self-medication or unsolicited use of any herb, otherwise useful, like Aloe Vera, can have adverse effects on the patients.

The writer is a Ludhiana-based senior ayurvedic physician. E mail- yourhealth@rediffmail.com

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A common cause of low back pain
Dr Ravinder Chadha

Low back pain can be due to prolapsed disc but pain on the sides of the spine can be due to sacroilitis — i.e. inflammation of sacroiliac joint. Sacroiliac joint connects the spine to the pelvis. The stability of the joint is due to the support of ligaments; hence the degree of movement is limited.

As in most joints, a cartilage covers the bones thereby acting as a shock-absorber. In the event of damage to the cartilage due to injury or being worn out owing to aging and degeneration, the bones start to rub against each other causing dysfunction disability. Chronic pain in the buttocks can also be due to disc prolapse or sacroilitis.

Causes

Sacroiliac joint ligament strain occurs in females during pregnancy. The hormones released during pregnancy allow the ligaments to relax and prepare the body for childbirth. Sometimes the relaxation of ligaments may cause stress and abnormal wear and tear. Adding to this is the increase in weight and waddling gait putting more pressure on the joint. Certain afflictions like ankylosis spondylitis, gout and rheumatic arthritis also cause sacroiliac joint dysfunction.

The conditions which alter the gait pattern puts increased stress on the joint. These include knee arthritis /hip pain/ankle pain/foot pain and leg length insufficiency. On rectifying the underlying problem, sacroiliac joint dysfunction can also be effectively improved. Ligament injury or laxity owing to injury, poor posture and faulty lifting techniques all lead to stress on the lower back.

Symptoms

lPain experienced on the sides of the spine which may radiate to the hip, thigh and groin.
lPain aggravates on standing/walking and improves while lying down.
lPain is usually aggravated on change in the posture vis-a-vis getting up from a sitting position, rolling in the bed, etc.
lPain felt on sitting cross-legged or placing one leg on the other.

Treatment

lUltrasound massage
lManipulation, if done correctly, brings immediate relief.
lInjection steroid into the joint is very effective
lAerobic activity-cycling, swimming (if pain increases on running) and walking.

Exercises

1. Lying on the back, slide the affected side foot upward towards the buttock, raising the knee. Slowly lower the bent knee to the outside, keeping the heel against the knee. Return back. Repeat 10 times.

2. Lying face down, raise the affected leg upwards, keeping the knee straight while keeping the hips on the floor. Return back. Repeat 10 times.

3. Lying on the stomach, raise the affected leg and the opposite arm simultaneously upwards. Repeat 10 times.

The precautions

lProper warming up prior to initiating any physical activity will ensure adequate shock absorption and strong support for the joints.
lIdentifying the activities that cause pain will go a long way in preventing future discomfort.
lExercises undertaken to strengthen the muscles around the hips help hold the joint together and provide additional shock absorption on the spine.

Prevention, as they say, is better than cure. The aim should be to take precautions so as to become a candidate for sacroilitis. Once pain sets in early intervention is mandatory to control it.

The writer is a former doctor/physiotherapist, Indian Cricket Team, and runs a pain management clinic in Chandigarh.

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Health Notes
Drinking coffee may reduce stroke risk among women

SYDNEY: Drinking coffee could lower women's risk of suffering a stroke, a new study has suggested.

The study of 83,000 women, conducted over a 24-year period by Harvard Medical School and Harvard School of Public Health in Boston, revealed that women who drank five to seven cups of coffee a week were 12 per cent less likely to have a stroke than were those who downed just one cup a month.

However, German experts on stroke prevention in Berlin say that the benefit does not appear to come from caffeine, reports the Sydney Morning Herald. Professor Martin Grond of the German Stroke Society said that those who drank tea and other caffeinated drinks did not experience the same reduction in stroke risk. — ANI

Soon, just a drop of  blood to spot cancer

LONDON: Just a drop of blood or a chunk of very tiny tissue is all that will be required to diagnose cancers and assess their response to treatment if scientists have their way.

In a recently study, researchers at the Stanford University School of Medicine used a specialised machine that was capable of analysing whether individual cancer-associated proteins were present in the tiny samples, and even whether modifications of the proteins varied in response to cancer treatments.

The study focussed on blood cancers, but the research team is optimistic that their technique may some day provide a faster, less invasive way to track solid tumours.

"Currently we don't know what's going on in a patient's actual tumor cells when a treatment is given," Nature magazine quoted oncologist Dr. Alice Fan, a clinical instructor in the division of oncology at the medical school, as saying. — ANI

Weight-loss surgery cuts  diabetes risk, improves fertility

WASHINGTON: For people considering weight loss surgery, the operation can offer significant health benefits, ranging from reversal of Type 2 diabetes to improving fertility and increasing an individual's lifespan, says an expert.

Dr Nick Nicholson, weight loss surgeon on the medical staff at Baylor Regional Medical Centre at Plano, revealed how surgery can actually improve certain health conditions.

"Because obesity is the primary risk factor for Type 2 diabetes, weight-loss surgery can have a profound impact on the condition," said Dr. Nicholson.

A study showed that 82 per cent reversed their diabetes in less than two years.

The surgery can also improve fertility. Although most obese women are not infertile, ovulatory functions and pregnancy rates frequently improve significantly after weight loss in obese women. — ANI

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