A triple burden of malnutrition โ under-nutrition, micro-nutrient malnutrition, as well as overweight and obesity โ is rising in India. Paradoxically, these forms of poor nutrition often have the same nutritional root cause. More nourishing freshly cooked home-foods or more natural foods are being replaced by cheaper pre-processed packaged alternatives with high levels of salt, sugar and fat that fill the stomach, but do not nourish and in fact promote ill health and disease.
India is the diabetic capital of the world, with the highest concentration of diabetics in any single country. Hypertension closely follows, leading to an overall non-communicable disease (NCD) burden reaching epidemic proportions. A major pathway leading here is the rise of overweight and obesity, as a consequence of poor diets combining with sedentary lifestyles.
ย ย ย ย ย Health star ratings are designed by the powerful food industry to mislead the consumer. If the government is serious about the epidemic of obesity and non-communicable diseases, the consumer needs to be cautioned about junk foods through warningโ labels, public health experts gathered at the National Conclave on Sustainable Food Systemsโ, organized by the Centre for Science and Environment (CSE) in Nimli, Rajasthan, said.
The government should issue a warningโ label on packaged junk foods instead of health star ratings as they are misleading and doing more harm to customers than good, health experts said on Wednesday. Health star rating is a labelling system that grades packaged foods on the scale of one to five stars.
By pushing these, the Food Safety and Standards Authority of India (FSSAI) will give license to glorify junk foods, which is the opposite of what should be done, Director General, CSE, said while leading the expert deliberation on the Need for front-of-pack warning labels on ultra-processed junk foodsโ. Health star ratings are designed by the powerful food industry to mislead the consumer.
ย Front-of-pack labelling on packaged foods was first recommended by ย the FSSAI-led committee formed in 2013. CSE was part of this committee. FSSAI then came up with a draft regulation in 2018, which had strict thresholds limits to know unhealthy levels based on those developed by the WHO for countries like India in the South-East Asia Region.Due to industry pressure, FSSAI came up with another draft in 2019.
The food industry was still not pleased and this draft was repealed.
From January-June 2021, stakeholder consultations were held on the labelling design to be adopted, thresholds to made applicable and nutrients to be displayed.
CSE has documented all delays and dilutions until June 2021, the organisation alleged in a statement.
The latest consultation took place in February during which it was made clear that FSSAI plans to go ahead with the Health Star Ratingโ.
The sole objective of the stakeholder consultations, which were heavily dominated by the packaged food industry, was to come up with a labelling system, which is industry-friendly, said Khurana, who was part of these consultations, adding that all this while, FSSAI has been insensitive to the information needs of the consumer.
He alleged that the statutory body also ignored the global best practices and evidence around it. Instead, in an orchestrated way, through the scientific panel and commissioned studies, it is now getting ready to adopt a labelling system which is considered least effective and rejected across the world, he said.
Health star ratings are depicted based on an algorithm at the back-end, which is not known to consumers, CSE said, adding that it is only adopted voluntarily in few countries such as Australia and New Zealand and only some food products carry it.
It has been rejected in several other countries as it can mislead the consumer and be easily manipulated by the industry, the CSE said.The proven best practice in front-of-pack labelling is nutrient specific warningโ labels, experts said.They have been simple and effective in discouraging junk food consumption. Several Latin American countries, Canada and Israel have already adopted warning labels.Many other countries are considering them.
Among them, the best known are symbol-based warning labels such as that of Israel. These will be most suitable for India, as it would transcend the literature and language barriers, the CSE said.We have submitted our concerns to FSSAI. It canโt allow a system that will effectively nudge the consumer to make unhealthy choices.ย It will mislead the consumer because of its design, algorithm and inclusion of positive nutrients in the calculation.ย It canโt allow relaxed limits and voluntary adoption, Narain said.
Myocardial ischemia occurs when blood flow to your heart is reduced, preventing the heart muscle from receiving enough oxygen. The reduced blood flow is usually the result of a partial or complete blockage of your heart’s arteries (coronary arteries).
Myocardial ischemia, also called cardiac ischemia, reduces the heart muscle’s ability to pump blood. A sudden, severe blockage of one of the heart’s artery can lead to a heart attack. Myocardial ischemia might also cause serious abnormal heart rhythms.
Treatment for myocardial ischemia involves improving blood flow to the heart muscle. Treatment may include medications, a procedure to open blocked arteries (angioplasty) or bypass surgery.
Making heart-healthy lifestyle choices is important in treating and preventing myocardial ischemia.
Some people who have myocardial ischemia don’t have any signs or symptoms (silent ischemia).
When they do occur, the most common is chest pressure or pain, typically on the left side of the body (angina pectoris). Other signs and symptoms โ which might be experienced more commonly by women, older people and people with diabetes โ include:
Neck or jaw pain
Shoulder or arm pain
A fast heartbeat
Shortness of breath when you are physically active
Nausea and vomiting
Sweating
Fatigue
When to see a doctor
Get emergency help if you have severe chest pain or chest pain that doesn’t go away.
Causes
Myocardial ischemia occurs when the blood flow through one or more of your coronary arteries is decreased. The low blood flow decreases the amount of oxygen your heart muscle receives. Myocardial ischemia can develop slowly as arteries become blocked over time. Or it can occur quickly when an artery becomes blocked suddenly. Conditions that can cause myocardial ischemia include:
Coronary artery disease (atherosclerosis).ย Plaques made up mostly of cholesterol build up on your artery walls and restrict blood flow. Atherosclerosis is the most common cause of myocardial ischemia.
Blood clot.ย The plaques that develop in atherosclerosis can rupture, causing a blood clot. The clot might block an artery and lead to sudden, severe myocardial ischemia, resulting in a heart attack. Rarely, a blood clot might travel to the coronary artery from elsewhere in the body.
Coronary artery spasm.ย This temporary tightening of the muscles in the artery wall can briefly decrease or even prevent blood flow to part of the heart muscle. Coronary artery spasm is an uncommon cause of myocardial ischemia. Chest pain associated with myocardial ischemia can be triggered by: Physical exertionEmotional stressCold temperaturesCocaine useEating a heavy or large mealSexual intercourse Risk factors Factors that can increase your risk of developing myocardial ischemia include: Tobacco.ย Smoking and long-term exposure to secondhand smoke can damage the inside walls of arteries. The damage can allow deposits of cholesterol and other substances to collect and slow blood flow in the coronary arteries. Smoking causes the coronary arteries to spasm and may also increase the risk of blood clots.
Diabetes.ย Type 1 and type 2 diabetes are linked to an increased risk of myocardial ischemia, heart attack and other heart problems.
High blood pressure.ย Over time, high blood pressure can accelerate atherosclerosis, resulting in damage to the coronary arteries.
High blood cholesterol level.ย Cholesterol is a major part of the deposits that can narrow your coronary arteries. A high level of “bad” (low-density lipoprotein, or LDL) cholesterol in your blood may be due to an inherited condition or a diet high in saturated fats and cholesterol.
High blood triglyceride level.ย Triglycerides, another type of blood fat, also may contribute to atherosclerosis.
Obesity.ย Obesity is associated with diabetes, high blood pressure and high blood cholesterol levels.
Waist circumference.ย A waist measurement of more than 35 inches (89 centimeters) for women and 40 inches (102 cm) in men increases the risk of high blood pressure, diabetes, and heart disease.
Lack of physical activity.ย Not getting enough exercise contributes to obesity and is linked to higher cholesterol and triglyceride levels. People who get regular aerobic exercise have better heart health, which is associated with a lower risk of myocardial ischemia and heart attack. Exercise also reduces blood pressure.
Myocardial ischemia can lead to serious complications, including:
Heart attack.ย If a coronary artery becomes completely blocked, the lack of blood and oxygen can lead to a heart attack that destroys part of the heart muscle. The damage can be serious and sometimes fatal.
Irregular heart rhythm (arrhythmia).ย An abnormal heart rhythm can weaken your heart and may be life-threatening.
Heart failure.ย Over time, repeated episodes of ischemia may lead to heart failure. Prevention The same lifestyle habits that can help treat myocardial ischemia can also help prevent it from developing in the first place. Leading a heart-healthy lifestyle can help keep your arteries strong, elastic and smooth, and allow for maximum blood flow.
Diagnosis
Your doctor will start by asking questions about your medical history and with a physical exam. After that, your doctor might recommend:
Electrocardiogram (ECG).ย Electrodes attached to your skin record the electrical activity of your heart. Certain changes in your heart’s electrical activity may be a sign of heart damage.
Stress test.ย Your heart rhythm, blood pressure and breathing are monitored while you walk on a treadmill or ride a stationary bike. Exercise makes your heart pump harder and faster than usual, so a stress test can detect heart problems that might not be noticeable otherwise.
Echocardiogram.ย Sound waves directed at your heart from a wand-like device held to your chest produce video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged and isn’t pumping normally.
Stress echocardiogram.ย A stress echocardiogram is similar to a regular echocardiogram, except the test is done after you exercise in the doctor’s office on a treadmill or stationary bike.
Nuclear stress test.ย Small amounts of radioactive material are injected into your bloodstream. While you exercise, your doctor can watch as it flows through your heart and lungs โ allowing blood-flow problems to be identified.
Coronary angiography.ย A dye is injected into the blood vessels of your heart. Then a series of X-ray images (angiograms) are taken, showing the dye’s path. This test gives your doctor a detailed look at the inside of your blood vessels.
Cardiac CT scan.ย This test can determine if you have a buildup of calcium in your coronary arteries โ a sign of coronary atherosclerosis. The heart arteries can also be seen using CT scanning (coronary CT angiogram).
Treatment
The goal of myocardial ischemia treatment is to improve blood flow to the heart muscle. Depending on the severity of your condition, your doctor may recommend medications, surgery or both. Medications Medications to treat myocardial ischemia include:
Aspirin.ย A daily aspirin or other blood thinner can reduce your risk of blood clots, which might help prevent blockage of your coronary arteries. Ask your doctor before starting to take aspirin because it might not be appropriate if you have a bleeding disorder or if you’re already taking another blood thinner.
Nitrates.ย These medications widen arteries, improving blood flow to and from your heart. Better blood flow means your heart doesn’t have to work as hard.
Beta blockers.ย These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure so blood can flow to your heart more easily.
Calcium channel blockers.ย These medications relax and widen blood vessels, increasing blood flow in your heart. Calcium channel blockers also slow your pulse and reduce the workload on your heart.
Cholesterol-lowering medications.ย These medications decrease the primary material that deposits on the coronary arteries.
Angiotensin-converting enzyme (ACE) inhibitors.ย These medications help relax blood vessels and lower blood pressure. Your doctor might recommend anย ACEย inhibitor if you have high blood pressure or diabetes in addition to myocardial ischemia.ย ACEย inhibitors may also be used if you have heart failure or if your heart doesn’t pump blood effectively.
Ranolazine (Ranexa).ย This medication helps relax your coronary arteries to ease angina. Ranolazine may be prescribed with other angina medications, such as calcium channel blockers, beta blockers or nitrates.
Procedures to improve blood flow
Sometimes, more-aggressive treatment is needed to improve blood flow. Procedures that may help include:
Angioplasty and stenting.ย A long, thin tube (catheter) is inserted into the narrowed part of your artery. A wire with a tiny balloon is threaded into the narrowed area and inflated to widen the artery. A small wire mesh coil (stent) is usually inserted to keep the artery open.
Coronary artery bypass surgery.ย A surgeon uses a vessel from another part of your body to create a graft that allows blood to flow around the blocked or narrowed coronary artery. This type of open-heart surgery is usually used only for people who have several narrowed coronary arteries.
Enhanced external counterpulsation.ย This noninvasive outpatient treatment might be recommended if other treatments haven’t worked. Cuffs that have been wrapped around your legs are gently inflated with air then deflated. The resulting pressure on your blood vessels can improve blood flow to the heart. Lifestyle and home remedies
Lifestyle changes are an important part of treatment. To follow a heart-healthy lifestyle:
Quit smoking.ย Talk to your doctor about smoking cessation strategies. Also try to avoid secondhand smoke.
Manage underlying health conditions.ย Treat diseases or conditions that can increase your risk of myocardial ischemia, such as diabetes, high blood pressure and high blood cholesterol.
Eat a healthy diet.ย Limit saturated fat and eat lots of whole grains, fruits and vegetables. Know your cholesterol numbers and ask your doctor if you’ve reduced them to the recommended level.
Exercise.ย Talk to your doctor about starting a safe exercise plan to improve blood flow to your heart.
Maintain a healthy weight.ย If you’re overweight, talk to your doctor about weight-loss options.
Decrease stress.ย Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing. It’s important to have regular medical checkups. Some of the main risk factors for myocardial ischemia โ high cholesterol, high blood pressure and diabetes โ have no symptoms in the early stages. Early detection and treatment can set the stage for a lifetime of better heart health. ย
Hyperlipidemia (high cholesterol) means your blood has too many lipids (fats) in it. These can add up and lead to blockages in your blood vessels. This is why high cholesterol can put you at risk for a stroke or heart attack. But you can make lifestyle changes like eating healthier and exercising to lower your cholesterol. Medicine can help, too.
Hyperlipidemia, or high cholesterol, can let plaque collect inside your blood vessels and put you at risk of a heart attack or stroke. The good news is that you have the power to reduce your risk of heart attack and stroke. Exercising more and eating healthier are just two of the ways you can improve your cholesterol numbers. Taking medicine your provider orders makes a difference, too.
Hyperlipidemia, also known as dyslipidemia or high cholesterol, means you have too many lipids (fats) in your blood. Your liver creates cholesterol to help you digest food and make things like hormones. But you also eat cholesterol in foods from the meat and dairy aisles. Since your liver can make as much cholesterol as you need, the cholesterol in foods you eat is extra.
Too much cholesterol (200 to 239 mg/dL is borderline high and 240 mg/dL is high) is not healthy because it can create roadblocks in your artery highways where blood travels around to your body. This damages your organs. Bad cholesterol (LDL) is the most dangerous type because it causes hardened cholesterol deposits (plaque) to collect inside of your blood vessels. This makes it harder for your blood to get through, which puts you at risk for a stroke or heart attack.
Think of cholesterol, a kind of fat, as traveling in lipoprotein cars through your blood.
Low-density lipoprotein (LDL) is known as bad cholesterol because it can clog your arteries like a large truck that broke down and is blocking a traffic lane. (Borderline high number: 130 to 159 mg/dL. High: 160 to 189 mg/dL.)
Very low density lipoprotein (VLDL) is also called bad because it carries triglycerides that add to artery plaque. This is another type of traffic blocker.
High-density lipoprotein (HDL) is known as good cholesterol because it brings cholesterol to your liver, which gets rid of it. This is like the tow truck that removes the broken down vehicles from the traffic lanes so vehicles can move. In this case, itโs clearing the way for your blood to get through your blood vessels. For your HDL, you donโt want to have a number lower than 40 mg/dL.
Itโs important to know that providers consider other factors in addition to your cholesterol numbers when they make treatment decisions.
Is hyperlipidemia the same as high cholesterol?
Yes, hyperlipidemia is another name for high cholesterol, and so is hypercholesterolemia.
What is dyslipidemia vs. hyperlipidemia?
They are mostly interchangeable terms for abnormalities in cholesterol. Your cholesterol can be โdysfunctionalโ (cholesterol particles that are very inflammatory or an abnormal balance between bad and good cholesterol levels) without being high. Both a high level of cholesterol and increased inflammation in โnormalโ cholesterol levels put you at increased risk for heart disease.
Several things can put you at a higher risk of hyperlipidemia, including:
Having a family history of high cholesterol.
Having hypothyroidism.
Having obesity.
Not eating a nutritious diet.
Drinking too much alcohol.
Having diabetes.
Smoking.
How common is hyperlipidemia?
Hyperlipidemia is very common. Ninety-three million American adults (age 20 and older) have a total cholesterol count above the recommended limit of 200 mg/dL.
How serious is hyperlipidemia?
Hyperlipidemia can be very serious if itโs not controlled. As long as high cholesterol is untreated, youโre letting plaque accumulate inside your blood vessels. This can lead to a heart attack or stroke because your blood has a hard time getting through your blood vessels. This deprives your brain and heart of the nutrients and oxygen they need to function. Cardiovascular disease is the leading cause of death in Americans.
How does hyperlipidemia affect my body?
Hyperlipidemia (high cholesterol) thatโs not treated can allow plaque to collect inside your bodyโs blood vessels (atherosclerosis). This can bring on hyperlipidemia complications that include:
Heart attack.
Stroke.
Coronary heart disease.
Carotid artery disease.
Sudden cardiac arrest.
Peripheral artery disease.
Microvascular disease.
SYMPTOMS AND CAUSES
What are the symptoms of hyperlipidemia?
Most people donโt have symptoms when their cholesterol is high. People who have a genetic problem with cholesterol clearance that causes very high cholesterol levels may get xanthomas (waxy, fatty plaques on the skin) or corneal arcus (cholesterol rings around the iris of the eye).
What causes hyperlipidemia?
Various hyperlipidemia causes include:
Smoking.
Drinking a lot of alcohol.
Eating foods that have a lot of saturated fats or trans fats.
Sitting too much instead of being active.
Being stressed.
Inheriting genes that make your cholesterol levels unhealthy.
Being overweight.
Medications that are helpful for some problems can make your cholesterol levels fluctuate, such as:
Beta blockers.
Diuretics.
Hormonal birth control.
Steroids.
Antiretrovirals for HIV.
Medical problems can also affect how much cholesterol you have. These include:
Multiple myeloma.
Polycystic ovary syndrome (PCOS).
Hypothyroidism.
Primary biliary cirrhosis.
Chronic kidney disease.
Diabetes.
Lupus.
Sleep apnea.
HIV.
DIAGNOSIS AND TESTS
How is hyperlipidemia diagnosed?
Your provider will want:
A physical exam.
Your medical history.
Your familyโs medical history.
To calculate your 10 year Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score.
A blood test called a lipid panel will tell you these numbers:
Type of cholesterol
Best number to have
Total cholesterol
Less than 200 mg/dL
Bad (LDL) cholesterol
Less than 100 mg/dL
Good (HDL) cholesterol
At least 60 mg/dL
Triglycerides
Less than 150 mg/dL
What tests will be done to diagnose hyperlipidemia?
Your provider may also do these tests:
High sensitivity C-reactive protein (hs-CRP).
Lipoprotein (a).
Apolipoprotein B.
Coronary calcium scan.
MANAGEMENT AND TREATMENT
How is hyperlipidemia treated?
Changing their lifestyles may be all some people need to do to improve their cholesterol numbers. For other people, thatโs not enough and they need medication.
Things you can do include:
Exercising.
Quitting smoking.
Sleeping at least seven hours each night.
Keeping your stress level under control.
Eating healthier foods.
Limiting how much alcohol you drink.
Losing a few pounds to reach a healthy weight.
What medications are used for hyperlipidemia?
People who need medicine to treat their high cholesterol usually take statins. Your provider may order a different type of medicine if:
You canโt take a statin.
You need another medicine in addition to a statin.
You have familial hypercholesterolemia, a genetic problem that makes your bad (LDL) cholesterol number extremely high.
Are there side effects of hyperlipidemia treatment?
Any medication can have side effects, but the benefits of statins far outweigh the risks of minor side effects. Let your provider know if you arenโt doing well on your medicine so they can develop a plan to manage your symptoms.
How soon will the hyperlipidemia treatment start working?
Your provider will order another blood test about two or three months after you start taking hyperlipidemia medication. The test results will show if your cholesterol levels have improved, which means the medicine and/or lifestyle changes are working.
PREVENTION
How can I reduce my risk of hyperlipidemia?
Even children can get their blood checked for high cholesterol, especially if someone in the childโs family had a heart attack, stroke or high cholesterol. Children and young adults can get checked every five years.
Once you reach middle age, you should have your cholesterol checked every year or two. Your healthcare provider can help you decide how often you should have a hyperlipidemia screening.
How can I prevent hyperlipidemia?
Changes you make in your life can keep you from getting hyperlipidemia. Things you can do include:
Stop smoking.
Stay active instead of sitting too much.
Keep your stress level down.
Get the right amount of sleep.
Eat healthy foods.
Cut back on eating fatty meats.
Donโt buy snacks that have โtrans fatโ on the label.
Stay at a healthy weight.
OUTLOOK / PROGNOSIS
What can I expect if I have hyperlipidemia?
If you have hyperlipidemia, youโll need to keep using healthy lifestyle habits for years to come. Youโll also need to keep follow-up appointments with your provider and continue to take your medicine.
How long will you have hyperlipidemia?
Hyperlipidemia is a condition youโll need to manage for the rest of your life.
What is the outlook for hyperlipidemia?
Although high cholesterol puts you at risk for heart attacks and stroke, you can protect yourself by living a healthier lifestyle and taking medicine if needed.
LIVING WITH
How do I take care of myself with hyperlipidemia?
Be sure to follow your providerโs instructions for making your lifestyle healthier.
Here are things you can do yourself:
Exercise.
Stop smoking.
Sleep at least seven hours each night.
Control your stress level.
Eat healthier foods.
Limit how much alcohol you drink.
Stay at a healthy weight.
Other things you can do:
If your provider ordered medicine for you, be sure to keep taking it as the label tells you to do.
Keep your follow-up appointments.
When should I see my healthcare provider?
You should see your provider if you have:
High blood sugar.
High blood pressure.
High cholesterol.
What questions should I ask my doctor?
Do I need to make lifestyle changes, take medication or both?
If I do what you tell me to do, how quickly can my numbers improve?
High blood pressure (hypertension) is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.
Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure. A blood pressure reading is given in millimeters of mercury (mm Hg). It has two numbers.
Top number (systolic pressure). The first, or upper, number measures the pressure in your arteries when your heart beats.
Bottom number (diastolic pressure). The second, or lower, number measures the pressure in your arteries between beats.
You can have high blood pressure for years without any symptoms. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.
Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.
A few people with high blood pressure may have headaches, shortness of breath or nosebleeds, but these signs and symptoms aren’t specific and usually don’t occur until high blood pressure has reached a severe or life-threatening stage.
When to see a doctor
You’ll likely have your blood pressure taken as part of a routine doctor’s appointment.
Ask your doctor for a blood pressure reading at least every two years starting at age 18. If you’re age 40 or older, or you’re 18 to 39 with a high risk of high blood pressure, ask your doctor for a blood pressure reading every year.
Blood pressure generally should be checked in both arms to determine if there’s a difference. It’s important to use an appropriate-sized arm cuff.
Your doctor will likely recommend more-frequent readings if you’ve already been diagnosed with high blood pressure or have other risk factors for cardiovascular disease. Children age 3 and older will usually have blood pressure measured as a part of their yearly checkups.
If you don’t regularly see your doctor, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in some stores that will measure your blood pressure for free.
Public blood pressure machines, such as those found in pharmacies, may provide helpful information about your blood pressure, but they may have some limitations. The accuracy of these machines depends on several factors, such as a correct cuff size and proper use of the machines. Ask your doctor for advice on using public blood pressure machines.
For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.
Secondary hypertension
Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:
Obstructive sleep apnea
Kidney disease
Adrenal gland tumors
Thyroid problems
Certain defects you’re born with (congenital) in blood vessels
Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
Illegal drugs, such as cocaine and amphetamines
Risk factors
High blood pressure has many risk factors, including:
Age. The risk of high blood pressure increases as you age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
Race. High blood pressure is particularly common among people of African heritage, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack and kidney failure, also are more common in people of African heritage.
Family history. High blood pressure tends to run in families.
Being overweight or obese. The more you weigh, the more blood you need to supply oxygen and nutrients to your tissues. As the amount of blood flow through your blood vessels increases, so does the pressure on your artery walls.
Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk.
Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. A proper balance of potassium is critical for good heart health. If you don’t get enough potassium in your diet, or you lose too much potassium due to dehydration or other health conditions, sodium can build up in your blood.
Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure.
If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
Stress. High levels of stress can lead to a temporary increase in blood pressure. Stress-related habits such as eating more, using tobacco or drinking alcohol can lead to further increases in blood pressure.
Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, including kidney disease, diabetes and sleep apnea.
Sometimes pregnancy contributes to high blood pressure as well.
Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits โ such as an unhealthy diet and lack of exercise โ contribute to high blood pressure.
The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels as well as your organs. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.
Uncontrolled high blood pressure can lead to complications including:
Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
Heart failure. To pump blood against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart’s pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body’s needs, which can lead to heart failure.
Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
Metabolic syndrome. This syndrome is a group of disorders of your body’s metabolism, including increased waist size, high triglycerides, decreased high-density lipoprotein (HDL) cholesterol (the “good” cholesterol), high blood pressure and high insulin levels. These conditions make you more likely to develop diabetes, heart disease and stroke.
Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.
Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia.
Diagnosis
Blood pressure measurement
Your doctor will ask questions about your medical history and do a physical examination. The doctor, nurse or other medical assistant will place an inflatable arm cuff around your arm and measure your blood pressure using a pressure-measuring gauge.
Your blood pressure generally should be measured in both arms to determine if there is a difference. It’s important to use an appropriate-sized arm cuff.
Blood pressure measurements fall into several categories:
Normal blood pressure.ย Your blood pressure is normal if it’s below 120/80 mm Hg.
Elevated blood pressure.ย Elevated blood pressure is a systolic pressure ranging from 120 to 129 mm Hg and a diastolic pressure below (not above) 80 mm Hg. Elevated blood pressure tends to get worse over time unless steps are taken to control blood pressure. Elevated blood pressure may also be called prehypertension.
Stage 1 hypertension.ย Stage 1 hypertension is a systolic pressure ranging from 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg.
Stage 2 hypertension.ย More-severe hypertension, stage 2 hypertension is a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher.
Hypertensive crisis.ย A blood pressure measurement higher than 180/120 mm Hg is an emergency situation that requires urgent medical care. If you get this result when you take your blood pressure at home, wait five minutes and retest. If your blood pressure is still this high, contact your doctor immediately. If you also have chest pain, vision problems, numbness or weakness, breathing difficulty, or any other signs and symptoms of a stroke or heart attack, call local emergency medical number.
Both numbers in a blood pressure reading are important. But after age 50, the systolic reading is even more important. Isolated systolic hypertension is a condition in which the diastolic pressure is normal (less than 80 mm Hg) but systolic pressure is high (greater than or equal to 130 mm Hg). This is a common type of high blood pressure among people older than 65.
Because blood pressure normally varies during the day and may increase during a doctor visit (white coat hypertension), your doctor will likely take several blood pressure readings at three or more separate appointments before diagnosing you with high blood pressure.
Microsoft Corp. said Zain Nadella, son of Chief Executive Officer Satya and his wife Anu, died Monday morning. He was 26 years old and had been born with cerebral palsy. The software maker told its executive staff in an email that Zain had passed away. The message asked executives to hold the family in their thoughts and prayers while giving them space to grieve privately.
Cerebral palsy is a group of disorders that affect movement and muscle tone or posture. It’s caused by damage that occurs to the immature, developing brain, most often before birth.
Signs and symptoms appear during infancy or preschool years. In general, cerebral palsy causes impaired movement associated with exaggerated reflexes, floppiness or spasticity of the limbs and trunk, unusual posture, involuntary movements, unsteady walking, or some combination of these.
People with cerebral palsy can have problems swallowing and commonly have eye muscle imbalance, in which the eyes don’t focus on the same object. They also might have reduced range of motion at various joints of their bodies due to muscle stiffness.
The cause of cerebral palsy and its effect on function vary greatly. Some people with cerebral palsy can walk; others need assistance. Some people have intellectual disabilities, but others do not. Epilepsy, blindness or deafness also might be present. Cerebral palsy is a lifelong disorder. There is no cure, but treatments can help improve function.
Signs and symptoms of cerebral palsy can vary greatly from person to person. Cerebral palsy can affect the whole body, or it might be limited primarily to one or two limbs, or one side of the body. Generally, signs and symptoms include problems with movement and coordination, speech and eating, development, and other problems.
Movement and coordination
Stiff muscles and exaggerated reflexes (spasticity), the most common movement disorder
Variations in muscle tone, such as being either too stiff or too floppy
Stiff muscles with normal reflexes (rigidity)
Lack of balance and muscle coordination (ataxia)
Tremors or jerky involuntary movements
Slow, writhing movements
Favoring one side of the body, such as only reaching with one hand or dragging a leg while crawling
Difficulty walking, such as walking on toes, a crouched gait, a scissors-like gait with knees crossing, a wide gait or an asymmetrical gait
Difficulty with fine motor skills, such as buttoning clothes or picking up utensils
Speech and eating
Delays in speech development
Difficulty speaking
Difficulty with sucking, chewing or eating
Excessive drooling or problems with swallowing
Development
Delays in reaching motor skills milestones, such as sitting up or crawling
Learning difficulties
Intellectual disabilities
Delayed growth, resulting in smaller size than would be expected
Other problems
Damage to the brain can contribute to other neurological problems, such as:
Seizures (epilepsy)
Difficulty hearing
Problems with vision and abnormal eye movements
Abnormal touch or pain sensations
Bladder and bowel problems, including constipation and urinary incontinence
Mental health conditions, such as emotional disorders and behavioral problems
The brain disorder causing cerebral palsy doesn’t change with time, so the symptoms usually don’t worsen with age. However, as the child gets older, some symptoms might become more or less apparent. And muscle shortening and muscle rigidity can worsen if not treated aggressively.
When to see a doctor
It’s important to get a prompt diagnosis for a movement disorder or delays in your child’s development. See your child’s doctor if you have concerns about episodes of loss of awareness of surroundings or of unusual bodily movements or muscle tone, impaired coordination, swallowing difficulties, eye muscle imbalance, or other developmental issues.
Cerebral palsy is caused by abnormal brain development or damage to the developing brain. This usually happens before a child is born, but it can occur at birth or in early infancy. In many cases, the cause isn’t known. Many factors can lead to problems with brain development. Some include:
Gene mutations that result in genetic disorders or differences in brain development
Maternal infections that affect the developing fetus
Fetal stroke, a disruption of blood supply to the developing brain
Bleeding into the brain in the womb or as a newborn
Infant infections that cause inflammation in or around the brain
Traumatic head injury to an infant, such as from a motor vehicle accident, fall or physical abuse
Lack of oxygen to the brain related to difficult labor or delivery, although birth-related asphyxia is much less commonly a cause than historically thought
Risk factors
A number of factors are associated with an increased risk of cerebral palsy.
Maternal health
Certain infections or toxic exposures during pregnancy can significantly increase cerebral palsy risk to the baby. Inflammation triggered by infection or fever can damage the unborn baby’s developing brain.
Cytomegalovirus. This common virus causes flu-like symptoms and can lead to birth defects if a mother has her first active infection during pregnancy.
German measles (rubella). This viral infection can be prevented with a vaccine.
Herpes. This infection can be passed from mother to child during pregnancy, affecting the womb and placenta.
Syphilis. This is a sexually transmitted bacterial infection.
Toxoplasmosis. This infection is caused by a parasite found in contaminated food, soil and the feces of infected cats.
Zika virus infection. This infection is spread through mosquito bites and can affect fetal brain development.
Intrauterine infections. This includes infections of the placenta or fetal membranes.
Exposure to toxins. One example is exposure to methyl mercury.
Other conditions. Other conditions affecting the mother that can slightly increase the risk of cerebral palsy include thyroid problems, preeclampsia or seizures.
Infant illness
Illnesses in a newborn baby that can greatly increase the risk of cerebral palsy include:
Bacterial meningitis. This bacterial infection causes inflammation in the membranes surrounding the brain and spinal cord.
Viral encephalitis. This viral infection similarly causes inflammation in the membranes surrounding the brain and spinal cord.
Severe or untreated jaundice. Jaundice appears as a yellowing of the skin. The condition occurs when certain byproducts of “used” blood cells aren’t filtered from the bloodstream.
Bleeding into the brain. This condition is commonly caused by the baby having a stroke in the womb or in early infancy.
Factors of pregnancy and birth
While the potential contribution from each is limited, additional pregnancy or birth factors associated with increased cerebral palsy risk include:
Low birth weight. Babies who weigh less than 5.5 pounds (2.5 kilograms) are at higher risk of developing cerebral palsy. This risk increases as birth weight drops.
Multiple babies. Cerebral palsy risk increases with the number of babies sharing the uterus. The risk also can be related to the likelihood of premature birth and low birth weight. If one or more of the babies die, the survivors’ risk of cerebral palsy increases.
Premature birth. Babies born prematurely are at higher risk of cerebral palsy. The earlier a baby is born, the greater the cerebral palsy risk.
Delivery complications. Problems during labor and delivery may increase the risk of cerebral palsy.
Complications
Muscle weakness, muscle spasticity and coordination problems can contribute to a number of complications either during childhood or in adulthood, including:
Contracture. Contracture is muscle tissue shortening due to severe muscle tightening that can be the result of spasticity. Contracture can inhibit bone growth, cause bones to bend, and result in joint deformities, dislocation or partial dislocation. These can include hip dislocation, curvature of the spine (scoliosis) and other orthopedic deformities.
Malnutrition. Swallowing or feeding problems can make it difficult for someone who has cerebral palsy, particularly an infant, to get enough nutrition. This can impair growth and weaken bones. Some children or adults need a feeding tube to get enough nutrition.
Mental health conditions. People with cerebral palsy might have mental health conditions, such as depression. Social isolation and the challenges of coping with disabilities can contribute to depression. Behavioral problems can also occur.
Heart and lung disease. People with cerebral palsy may develop heart disease, lung disease and breathing disorders. Problems with swallowing can result in respiratory problems, such as aspiration pneumonia.
Osteoarthritis. Pressure on joints or abnormal alignment of joints from muscle spasticity may lead to the early onset of this painful degenerative bone disease.
Osteoporosis. Fractures due to low bone density can result from several factors such as lack of mobility, inadequate nutrition and anti-epileptic drug use.
Other complications. These can include sleep disorders, chronic pain, skin breakdown, intestinal problems and issues with oral health.
Prevention
Most cases of cerebral palsy can’t be prevented, but you can reduce risks. If you’re pregnant or planning to become pregnant, you can take these steps to keep healthy and minimize pregnancy complications:
Make sure you’re vaccinated. Getting vaccinated against diseases such as rubella, preferably before getting pregnant, might prevent an infection that could cause fetal brain damage.
Take care of yourself. The healthier you are heading into a pregnancy, the less likely you’ll be to develop an infection that results in cerebral palsy.
Seek early and continuous prenatal care. Regular visits to your doctor during your pregnancy are a good way to reduce health risks to you and your unborn baby. Seeing your doctor regularly can help prevent premature birth, low birth weight and infections.
Avoid alcohol, tobacco and illegal drugs. These have been linked to cerebral palsy risk.
Rarely, cerebral palsy can be caused by brain damage that occurs in childhood. Practice good general safety. Prevent head injuries by providing your child with a car seat, bicycle helmet, safety rails on the bed and appropriate supervision.
Many have woken up to Indiaโs plastic waste generation problem after worrying data was presented in Parliament. But alarm bells have been ringing for a long time. According to the Centre, plastic waste generation has more than doubled in the last five years, with an average annual increase of 21.8%. A 2018-2019 Central Pollution Control Board (CPCB) report puts Indiaโs annual plastic waste generation at 3.3 million metric tonnes. This, according to experts, is an underestimation. Seven states โ Maharashtra, Delhi, Karnataka, Uttar Pradesh, Gujarat, West Bengal, and Tamil Nadu โ contribute to 66% of the countryโs total plastic generation. And, Goa and Delhiโs per capita plastic use is six times higher than the national average. A 2018 study by IIT Kharagpur found that 49% of waste in Delhi drains was plastic.
There is need for robust national plan, ensure transparency and to involve every stakeholder- from Government and industries to every last citizen.
New Delhi [India], February 18 (ANI): Taking forward the commitment to eliminate single-use plastics, the Environment Ministry has notified comprehensive guidelines on Extended Producer Responsibility (EPR) for plastic packaging under Plastic Waste Management Rules, 2016.
According to the Ministry of Environment, Forest and Climate Change, the guidelines on extended producer responsibility coupled with the prohibition of identified single-use plastic items, which have low utility and high littering potential, with effect from July 1, 2022, are important steps for reducing pollution caused by littered plastic waste in the country.
The minister said that the guidelines provide a framework to strengthen the circular economy of plastic packaging waste, promote the development of new alternatives to plastics and provide further next steps for moving towards sustainable plastic packaging by businesses. โReuse of rigid plastic packaging material has been mandated in the guidelines to reduce the use of fresh plastic material for packaging,โ Yadav said.
The Ministry said that the enforceable prescription of a minimum level of recycling of plastic packaging waste collected under EPR along with the use of recycled plastic content will further reduce plastic consumption and support the recycling of plastic packaging waste.
The EPR guidelines will give a boost for formalization and further development of the plastic waste management sector. As a significant first, the guidelines allow for the sale and purchase of surplus extended producer responsibility certificates, thus setting up a market mechanism for plastic waste management.
โThe implementation of EPR will be done through a customized online platform which will act as the digital backbone of the system. The online platform will allow tracking and monitoring of EPR obligations and reduce the compliance burden for companies through online registration and filing of annual returns. In order to ensure monitoring on fulfilment of EPR obligations, the guidelines have prescribed a system of verification and audit of enterprises,โ it said.
The guidelines prescribe a framework for the levy of environmental compensation based upon the polluter pays principle, with respect to non-fulfilment of extended producer responsibility targets by producers, importers and brand owners, for the purpose of protecting and improving the quality of the environment and preventing, controlling and abating environment pollution, the Ministry added.
It further said that the funds collected shall be utilized for collection, recycling and end of life disposal of uncollected plastic waste in an environmentally sound manner.
Under these producers, importers and brand owners may operate schemes such as deposit-refund system or buy-back or any other model in order to prevent the mixing of plastic packaging waste with solid waste. (ANI)
NEW DELHI: Has the Covid-19 pandemic worsened addiction to the internet among children? The footfall at psychiatric out-patient departments in hospitals, especially those offering help to kids hooked to the net, be it for online gaming, chatting with friends or sharing videos, offers a glimpse of the problem. At AIIMS, the number of parents seeking help for their children, among them the most being those addicted to online gaming, has increased significantly after the pandemic. The special clinic was inundated with requests from parents seeking help, nearly 80% of them are related to online gaming, 15% about excessive use of social media and the remaining 5% related to problems like pornographyโ.
The parents of a Class XI student โ name withheld on request โ approached AIIMS because their son was gaming online for hours, and wasnโt willing to give up the habit. The son even hit his father when the latter tried to take away the laptop. In another case, a Class IX student hooked to online gambling spent Rs 75,000 in a single week on his parentโs credit card. ย Children have developed mental and emotional issues due to addiction to online streaming services. The girl would stay awake all night to finish the TV series and sleep during the day. It continued for six to seven months. She developed insomnia and began hallucinating, which is when the parents panicked and brought her to hospital. We had to put her on psychiatric medications and counselling. During the pandemic, however, the problem increased multiple times. The schools were closed and classes were being held online. This increased the childrenโs access to digital technologies. Secondly, social interactions shifted online due to restricted physical movement forced by Covid. ย They Spend more time online led to the addiction. As for online gaming, doctors said these activities were designed to attract young people and were addictive in nature. Online gaming causes the same kind of craving and withdrawal that you see with any other addiction such as substance abuse.
ย ย ย ย ย ย ย What is the solution to this? ย Internet use is one of the important pillars of learning and growth in todayโs time and, therefore, it may not be advisable to prevent school children from using it. ย It may be prudent to promote safe usage of the internet. Very importantly, parents should be aware of the warning signs in their children, for example behavioural changes, reduced interaction with family members, children spending most of their time in their rooms, irregular sleeping or eating habits and mood changes that may signal troublesome usage of the technologies. If the habit persists and worsens, it may be advisable to seek expert help. The problem of internet addiction isnโt limited to children belonging to particular social strata, the doctors said. โWe need to have more cyber addiction clinics in government hospitals so even those who cannot afford private treatment can seek timely help,โ said one senior medico. โIt can help prevent serious mental health issues in children and even save lives.โ The doctor added that most children suffering from internet addiction improved with behavioural therapy and counselling. It was only in rare cases that medical management became necessary, he added.
Asthma is a major noncommunicable disease (NCD), affecting both children and adults.
Inflammation and narrowing of the small airways in the lungs cause asthma symptoms, which can be any combination of cough, wheeze, shortness of breath and chest tightness.
Asthma affected an estimated 262 million people in 2019 and caused 461000 deaths.
Asthma is the most common chronic disease among children.
Inhaled medication can control asthma symptoms and allow people with asthma to lead a normal, active life.
Avoiding asthma triggers can also help to reduce asthma symptoms.
Most asthma-related deaths occur in low- and lower-middle income countries, where under-diagnosis and under-treatment is a challenge.
What is asthma?
Asthma is a long-term condition affecting children and adults. The air passages in the lungs become narrow due to inflammation and tightening of the muscles around the small airways. This causes asthma symptoms: cough, wheeze, shortness of breath and chest tightness. These symptoms are intermittent and are often worse at night or during exercise. Other common โtriggersโ can make asthma symptoms worse. Triggers vary from person to person, but can include viral infections (colds), dust, smoke, fumes, changes in the weather, grass and tree pollen, animal fur and feathers, strong soaps, and perfume.
The impact of asthma on daily life
Asthma is often under-diagnosed and under-treated, particularly in low- and middle-income countries.
People with under-treated asthma can suffer sleep disturbance, tiredness during the day, and poor concentration. Asthma sufferers and their families may miss school and work, with financial impact on the family and wider community. If symptoms are severe, people with asthma may need to receive emergency health care and they may be admitted to hospital for treatment and monitoring. In the most severe cases, asthma can lead to death.
Causes of asthma
Many different factors have been linked to an increased risk of developing asthma, although it is often difficult to find a single, direct cause.
Asthma is more likely if other family members also have asthma โ particularly a close relative, such as a parent or sibling.
Asthma is more likely in people who have other allergic conditions, such as eczema and rhinitis (hay fever).
Urbanisation is associated with increased asthma prevalence, probably due to multiple lifestyle factors.
Events in early life affect the developing lungs and can increase the risk of asthma. These include low-birth weight, prematurity, exposure to tobacco smoke and other sources of air pollution, as well as viral respiratory infections.
Exposure to a range of environmental allergens and irritants are also thought to increase the risk of asthma, including indoor and outdoor air pollution, house dust mites, moulds, and occupational exposure to chemicals, fumes, or dust.
Children and adults who are overweight or obese are at a greater risk of asthma.
Reducing the burden of asthma
Asthma cannot be cured, but good management with inhaled medications can control the disease and enable people with asthma to enjoy a normal, active life.
There are two main types of inhaler:
bronchodilators (such as salbutamol), that open the air passages and relieve symptoms; and
steroids (such as beclometasone), that reduce inflammation in the air passages. This improves asthma symptoms and reduces the risk of severe asthma attacks and death.
People with asthma may need to use their inhaler every day. Their treatment will depend on the frequency of symptoms and the different types of inhalers available.
It can be difficult to coordinate breathing using an inhaler โ especially for children and during emergency situations. Using a โspacerโ device makes it easier to use an aerosol inhaler and helps the medicine to reach the lungs more effectively. A spacer is a plastic container with a mouthpiece or mask at one end, and a hole for the inhaler in the other. A homemade spacer, made from a 500-ml plastic bottle, can be as effective as a commercially-manufactured inhaler.
People with asthma and their families need education to understand more about their asthma, their treatment, triggers to avoid, and how to manage their symptoms at home. It is also important to raise community awareness, to reduce the myths and stigma associated with asthma in some settings.
In an era, when even licensed and qualified doctors are finding it difficult to practice medicine, it is strange that unqualified and unlicensed are having a field day. Why strict regulations do not apply to them, is beyond any reasoning and logic. If a medical facility or clinic is functional, it is difficult for the patient, especially in emergency, to check or even doubt its credentials. How such facilities are open, functional and thriving. Sadly our regulation is trying to regulate, who are already regulated. It is trying to punish those who are qualified and licensed, but turns a blind eye towards unlicensed and unqualified doctors.
Such fake doctors own medical set ups, may conduct surgeries, sometimes run hospitals with little help from qualified doctors and do procedures. Another problem is that they promote fake rumours about genuinely qualified doctors and create a mist of mistrust to propagate their fake medical business.
ย The glans of an infantโs penis shrivelled and fell off after a quack tied a horseโs hair around it โto prevent bleedingโ after a ritual of circumcision. The child was rushed to hospital, where a surgery was performed to ensure that the baby will be able to urinate normally, but the boy has lost his glans.. A quack had conducted the religious ritual of circumcision on November 22, 2021, and tied a horse hair to the childโs penis. He then bandaged it and told the family to go home.
The child was born in October 2021. Ten days later, the family members noticed that the glans had come off along with the dressing. Families choose to get their male infants circumcised by neighbourhood quacks. This is not just unhygienic, but can lead to major complications as well. Other unhealthy practices like sprinkling ash on the wound after circumcision are also prevalent.
A toddler has died and his baby brother has required life-saving surgery in hospital after a medical procedure, understood to have been a circumcision, went horribly wrong in Perthโs south-east. The brothers were rushed to hospital in Armadale by family Tuesday evening following the surgeries. The West Australian reports a two-year-old boy was pronounced dead at the hospitalโs emergency department. His infant brother – aged between seven and eight months – was rushed to Perth Childrenโs Hospital for emergency surgery.7NEWS reports he has since been discharged from hospital. WA Police have confirmed the toddlerโs death is not being treated as suspicious. โIt can be confirmed the boy underwent a medical procedure at a registered medical centre prior to his death,โ a police spokeswoman said.
Circumcisionis one of the oldest surgical procedures and one of the most commonly performed surgical procedures in practice today. Descriptions of ritual circumcision span across cultures, and have been described in ancient Egyptian texts as well as the Old Testament.ย In the United States, circumcision is a commonly performed procedure. It is a relatively safe procedure with a low overall complication rate. Most complications are minor and can be managed easily. Though uncommon, complications of circumcision do represent a significant percentage of cases seen by paediatric urologists. Often they require surgical correction that results in a significant cost to the health care system. Severe complications are quite rare, but death has been reported as a result in some cases. A thorough and complete preoperative evaluation, focusing on bleeding history and birth history, is imperative. Proper selection of patients based on age and anatomic considerations as well as proper sterile surgical technique are critical to prevent future circumcision-related adverse events.
Symptoms of type 1 diabetes often appear suddenly and are often the reason for checking blood sugar levels. Because symptoms of other types of diabetes and prediabetes come on more gradually or may not be evident, the American Diabetes Association (ADA) has recommended screening guidelines. The ADA recommends that the following people be screened for diabetes:
Anyone with a body mass index higher than 25 (23 for Asian Americans), regardless of age, who has additional risk factors, such as high blood pressure, abnormal cholesterol levels, a sedentary lifestyle, a history of polycystic ovary syndrome or heart disease, and who has a close relative with diabetes.
Anyone older than age 45 is advised to receive an initial blood sugar screening, and then, if the results are normal, to be screened every three years thereafter.
Women who have had gestational diabetes are advised to be screened for diabetes every three years.
Anyone who has been diagnosed with prediabetes is advised to be tested every year.
Tests for type 1 and type 2 diabetes and prediabetes
Glycated hemoglobin (A1C) test. This blood test, which doesn’t require fasting, indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells.
The higher your blood sugar levels, the more hemoglobin you’ll have with sugar attached. An A1C level of 6.5% or higher on two separate tests indicates that you have diabetes. An A1C between 5.7 and 6.4 % indicates prediabetes. Below 5.7 is considered normal.
If the A1C test results aren’t consistent, the test isn’t available, or you have certain conditions that can make the A1C test inaccurate โ such as if you are pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) โ your doctor may use the following tests to diagnose diabetes:
Random blood sugar test. A blood sample will be taken at a random time. Regardless of when you last ate, a blood sugar level of 200 milligrams per deciliter (mg/dL) โ 11.1 millimoles per liter (mmol/L) โ or higher suggests diabetes.
Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it’s 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.
Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours.
A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours indicates diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes.
If type 1 diabetes is suspected, your urine will be tested to look for the presence of a byproduct produced when muscle and fat tissue are used for energy because the body doesn’t have enough insulin to use the available glucose (ketones). Your doctor will also likely run a test to see if you have the destructive immune system cells associated with type 1 diabetes called autoantibodies.
Tests for gestational diabetes
Your doctor will likely evaluate your risk factors for gestational diabetes early in your pregnancy:
If you’re at high risk of gestational diabetes โ for example, if you were obese at the start of your pregnancy; you had gestational diabetes during a previous pregnancy; or you have a mother, father, sibling or child with diabetes โ your doctor may test for diabetes at your first prenatal visit.
If you’re at average risk of gestational diabetes, you’ll likely have a screening test for gestational diabetes sometime during your second trimester โ typically between 24 and 28 weeks of pregnancy.
Your doctor may use the following screening tests:
Initial glucose challenge test. You’ll begin the glucose challenge test by drinking a syrupy glucose solution. One hour later, you’ll have a blood test to measure your blood sugar level. A blood sugar level below 140 mg/dL (7.8 mmol/L) is usually considered normal on a glucose challenge test, although this may vary at specific clinics or labs.
If your blood sugar level is higher than normal, it only means you have a higher risk of gestational diabetes. Your doctor will order a follow-up test to determine if you have gestational diabetes.
Follow-up glucose tolerance testing. For the follow-up test, you’ll be asked to fast overnight and then have your fasting blood sugar level measured. Then you’ll drink another sweet solution โ this one containing a higher concentration of glucose โ and your blood sugar level will be checked every hour for a period of three hours.
If at least two of the blood sugar readings are higher than the normal values established for each of the three hours of the test, you’ll be diagnosed with gestational diabetes.
Depending on what type of diabetes you have, blood sugar monitoring, insulin and oral medications may play a role in your treatment. Eating a healthy diet, maintaining a healthy weight and participating in regular activity also are important factors in managing diabetes.
Treatments for all types of diabetes
An important part of managing diabetes โ as well as your overall health โ is maintaining a healthy weight through a healthy diet and exercise plan:
Healthy eating.ย Contrary to popular perception, there’s no specific diabetes diet. You’ll need to center your diet on more fruits, vegetables, lean proteins and whole grains โ foods that are high in nutrition and fiber and low in fat and calories โ and cut down on saturated fats, refined carbohydrates and sweets. In fact, it’s the best eating plan for the entire family. Sugary foods are OK once in a while, as long as they’re counted as part of your meal plan.
Yet, understanding what and how much to eat can be a challenge. A registered dietitian can help you create a meal plan that fits your health goals, food preferences and lifestyle. This will likely include carbohydrate counting, especially if you have type 1 diabetes or use insulin as part of your treatment.
Physical activity. Everyone needs regular aerobic exercise, and people who have diabetes are no exception. Exercise lowers your blood sugar level by moving sugar into your cells, where it’s used for energy. Exercise also increases your sensitivity to insulin, which means your body needs less insulin to transport sugar to your cells.
Get your doctor’s OK to exercise. Then choose activities you enjoy, such as walking, swimming or biking. What’s most important is making physical activity part of your daily routine.
Aim for at least 30 minutes or more of aerobic exercise most days of the week, or at least 150 minutes of moderate physical activity a week. Bouts of activity can be as brief as 10 minutes, three times a day. If you haven’t been active for a while, start slowly and build up gradually. It’s also a good idea to avoid sitting for too long โ aim to get up and move if you’ve been sitting for more than 30 minutes.
Treatments for type 1 and type 2 diabetes
Treatment for type 1 diabetes involves insulin injections or the use of an insulin pump, frequent blood sugar checks, and carbohydrate counting. Treatment of type 2 diabetes primarily involves lifestyle changes, monitoring of your blood sugar, along with diabetes medications, insulin or both.
Monitoring your blood sugar. Depending on your treatment plan, you may check and record your blood sugar as many as four times a day or more often if you’re taking insulin. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. People with type 2 diabetes who aren’t taking insulin generally check their blood sugar much less frequently.
People who receive insulin therapy also may choose to monitor their blood sugar levels with a continuous glucose monitor. Although this technology hasn’t yet completely replaced the glucose meter, it can significantly reduce the number of fingersticks necessary to check blood sugar and provide important information about trends in blood sugar levels.
Even with careful management, blood sugar levels can sometimes change unpredictably. With help from your diabetes treatment team, you’ll learn how your blood sugar level changes in response to food, physical activity, medications, illness, alcohol, stress โ and for women, fluctuations in hormone levels.
In addition to daily blood sugar monitoring, your doctor will likely recommend regular A1C testing to measure your average blood sugar level for the past two to three months.
Compared with repeated daily blood sugar tests, A1C testing better indicates how well your diabetes treatment plan is working overall. An elevated A1C level may signal the need for a change in your oral medication, insulin regimen or meal plan.
Your target A1C goal may vary depending on your age and various other factors, such as other medical conditions you may have. However, for most people with diabetes, the American Diabetes Association recommends an A1C of below 7%. Ask your doctor what your A1C target is.
Insulin. People with type 1 diabetes need insulin therapy to survive. Many people with type 2 diabetes or gestational diabetes also need insulin therapy.
Many types of insulin are available, including short-acting (regular insulin), rapid-acting insulin, long-acting insulin and intermediate options. Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night.
Insulin can’t be taken orally to lower blood sugar because stomach enzymes interfere with insulin’s action. Often insulin is injected using a fine needle and syringe or an insulin pen โ a device that looks like a large ink pen.
An insulin pump also may be an option. The pump is a device about the size of a small cellphone worn on the outside of your body. A tube connects the reservoir of insulin to a catheter that’s inserted under the skin of your abdomen.
A tubeless pump that works wirelessly is also now available. You program an insulin pump to dispense specific amounts of insulin. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level.
In September 2016, the Food and Drug Administration approved the first artificial pancreas for people with type 1 diabetes who are age 14 and older. A second artificial pancreas was approved in December 2019. Since then systems have been approved for children older than 2 years old.
An artificial pancreas is also called closed-loop insulin delivery. The implanted device links a continuous glucose monitor, which checks blood sugar levels every five minutes, to an insulin pump. The device automatically delivers the correct amount of insulin when the monitor indicates it’s needed.
There are more artificial pancreas (closed loop) systems currently in clinical trials.
Oral or other medications. Sometimes other oral or injected medications are prescribed as well. Some diabetes medications stimulate your pancreas to produce and release more insulin. Others inhibit the production and release of glucose from your liver, which means you need less insulin to transport sugar into your cells.
Still others block the action of stomach or intestinal enzymes that break down carbohydrates or make your tissues more sensitive to insulin. Metformin (Glumetza, Fortamet, others) is generally the first medication prescribed for type 2 diabetes.
Another class of medication called SGLT2 inhibitors may be used. They work by preventing the kidneys from reabsorbing sugar into the blood. Instead, the sugar is excreted in the urine.
Transplantation. In some people who have type 1 diabetes, a pancreas transplant may be an option. Islet transplants are being studied as well. With a successful pancreas transplant, you would no longer need insulin therapy.
But transplants aren’t always successful โ and these procedures pose serious risks. You need a lifetime of immune-suppressing drugs to prevent organ rejection. These drugs can have serious side effects, which is why transplants are usually reserved for people whose diabetes can’t be controlled or those who also need a kidney transplant.
Bariatric surgery. Although it is not specifically considered a treatment for type 2 diabetes, people with type 2 diabetes who are obese and have a body mass index higher than 35 may benefit from this type of surgery. People who’ve undergone gastric bypass have seen significant improvements in their blood sugar levels. However, this procedure’s long-term risks and benefits for type 2 diabetes aren’t yet known.
Treatment for gestational diabetes
Controlling your blood sugar level is essential to keeping your baby healthy and avoiding complications during delivery. In addition to maintaining a healthy diet and exercising, your treatment plan may include monitoring your blood sugar and, in some cases, using insulin or oral medications.
Your doctor also will monitor your blood sugar level during labor. If your blood sugar rises, your baby may release high levels of insulin โ which can lead to low blood sugar right after birth.
Treatment for prediabetes
If you have prediabetes, healthy lifestyle choices can help you bring your blood sugar level back to normal or at least keep it from rising toward the levels seen in type 2 diabetes. Maintaining a healthy weight through exercise and healthy eating can help. Exercising at least 150 minutes a week and losing about 7% of your body weight may prevent or delay type 2 diabetes.
Sometimes medications โ such as metformin (Glucophage, Glumetza, others) โ also are an option if you’re at high risk of diabetes, including when your prediabetes is worsening or if you have cardiovascular disease, fatty liver disease or polycystic ovary syndrome.
In other cases, medications to control cholesterol โ statins, in particular โ and high blood pressure medications are needed. Your doctor might prescribe low-dose aspirin therapy to help prevent cardiovascular disease if you’re at high risk. However, healthy lifestyle choices remain key.
Signs of trouble in any type of diabetes
Because so many factors can affect your blood sugar, problems may sometimes arise that require immediate care, such as:
High blood sugar (hyperglycemia). Your blood sugar level can rise for many reasons, including eating too much, being sick or not taking enough glucose-lowering medication. Check your blood sugar level as directed by your doctor, and watch for signs and symptoms of high blood sugar โ frequent urination, increased thirst, dry mouth, blurred vision, fatigue and nausea. If you have hyperglycemia, you’ll need to adjust your meal plan, medications or both.
Increased ketones in your urine (diabetic ketoacidosis). If your cells are starved for energy, your body may begin to break down fat. This produces toxic acids known as ketones. Watch for loss of appetite, weakness, vomiting, fever, stomach pain and a sweet, fruity breath.
You can check your urine for excess ketones with an over-the-counter ketones test kit. If you have excess ketones in your urine, consult your doctor right away or seek emergency care. This condition is more common in people with type 1 diabetes.
Hyperglycemic hyperosmolar nonketotic syndrome. Signs and symptoms of this life-threatening condition include a blood sugar reading over 600 mg/dL (33.3 mmol/L), dry mouth, extreme thirst, fever, drowsiness, confusion, vision loss and hallucinations. Hyperosmolar syndrome is caused by sky-high blood sugar that turns blood thick and syrupy.
It is seen in people with type 2 diabetes, and it’s often preceded by an illness. Call your doctor or seek immediate medical care if you have signs or symptoms of this condition.
Low blood sugar (hypoglycemia). If your blood sugar level drops below your target range, it’s known as low blood sugar (hypoglycemia). If you’re taking medication that lowers your blood sugar, including insulin, your blood sugar level can drop for many reasons, including skipping a meal and getting more physical activity than normal. Low blood sugar also occurs if you take too much insulin or an excess of a glucose-lowering medication that promotes the secretion of insulin by your pancreas.
Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar โ sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision, heart palpitations, irritability, slurred speech, drowsiness, confusion, fainting and seizures. Low blood sugar is treated with quickly absorbed carbohydrates, such as fruit juice or glucose tablets.
Note- taken from Mayo clinic site for information purpose. treatment to be done by advice of a doctor
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