IHMA Karunagappally

Tuesday, March 17, 2009

Vitiligo.... Is it an autoimmune disease?

As we all know, Vitiligo is a loss of skin melanocytes that causes areas of skin depigmentation of varying sizes.

Incidence rate is comparatively higher in laborers of Gujarath, Rajasthan working in dyeing, and printing industry. 50 % of the affected groups are from below 20 yrs. Those affected below 10 yrs of age, Clinical manifestation of the disease - as a single nerve distribution unilaterally, known as dermatomal vitiligo. Family history play some role in about 18-20% of patients.

Vitiligo commonly involves the face, digits, dorsal hands,flexor digits,elbows,knees,shins,dorsal ankles,armpit,inguinal area,anogenital area,umbilicus and nipples.

Types

It may be Generalised Vitiligo: involving most of the skin surface

Segmental Vitiligo: Depigmentation may be localized, involving 1 or 2 spots or entire body segments

Vitiligo and autoimmunity

Etiology is unclear, According to some recent reasearches, the variation in the ratio of different lymphocytes and norepinephrin are the main causative elements .Exacerbation of the illiness noticed after various stressful states of the body such as injuries,pregnancy,delivery ,operations etc.

Vitiligo and autoimmune diseases

About 30% of vitiligo patients are also suffering from thyroid related autoimmune diseases. The strongest association is with hyperthyroidism (Grave's disease) and hypothyroidism (Hashimoto's thyroiditis), besides this existence of diabetis, pernicious anemia, addisons disease are also identified . However, the relationship is unclear and may be coincidental. These all lead to the speculation that it is an autoimmune disease

Saturday, March 14, 2009

New way assesment of long term Glucose control.

A change from Glycosylated Haemoglobin (HbA1c) to A1C Derived Average glucose(ADAG)

Glycosylated Haemoglobin

Advantage

It’s significance in the treatment of diabetes is commendable,because it shows the glucose status of previous three months. This number tells how well your diet, exercise, and medicine are working.An increase in A1c has been correlated with an increase in the risk of microvascular complications associated with diabetes.

Recommented values set byAmerican Diabetes Association, the Canadian Association of Diabetes and the European Association for the Study of Diabetes are as follows…

HbA1c reported in %.

>7% it iindicates the failure in diabetic treatment

<6.5%>

<6>

Normal person it is <5.4%

Disadvantage

Despite A1c being recognized as the standard measure of glucose control,number of general issues exist with the assay the · Many patients do not understand how to interpret the A1 c value,because it is expressed in % · Accuracy depends on the machines and the standardization method one is following. Though national glyco haemoglobin stanardisation programme have some recommendation in this aspect, it is not been followed all over the world. The above issues led the International federation of clinical chemistry to develop a reference method that is more specific to A1c and could be standardized worldwide.Globally now it’s named as A1 c derived average glucose(ADAG) A1 c derived average glucose(ADAG) or eAG

According to new criteria Hb A1c-derived average glucose or eAG is a new value which is used to assess long-term glucose control. The new system correlates A1c values with long-term control of glucose and is reported in units of mg/dL or mmol/L rather than a
percentage value.

After undergoing several clinical trial The equation identified for the Estimated average glucose is

Average glucose (mg/dL) =28.7 x A1c - 46.7
or
Average glucose (mmol/L) =1.59 x A1c – 2.59

A1c value / Estimated Average Glucose

5%................................97 mg/dL (5.4 mmol/L)
6%................................126 mg/dL (7 mmol/L)
7%................................154 mg/dL (8.5 mmol/L)
8%................................183 mg/dL (10.1 mmol/L)
9%................................212 mg/dL (11.7 mmol/L)
10%..............................240 mg/dL (13.3 mmol/L)
11%..............................269 mg/dL (14.9 mmol/L)
12%..............................298 mg/dL (16.5 mmol/L)

Problems with eAG
Although it improves patient understanding of their long-term glucose control,The equation utilizes a laboratory reported A1c value ,Inaccurate A1c values should be considered when the patient’s recorded self monitoring blood glucose values do not appear to coincide with the measured A1c value

( Certain other Factors which falsely increase A1c include:
· iron deficiency anemia
· patients without a spleen
A number of factors have inconsistent effects on
A1c and include:
· high vitamin C intake
· high vitamin E intake reduce the life span of a red blood cell.6 Factors

which falsely lower A1c include:
· recent acute blood loss
· hemolytic anemia
· chronic blood loss )

Live well with Mediterranean diet

What is ‘Mediterranean diet’ ?

Diet that have been followed by 21 countries that border the mediterrniansealike France,Spain,italy,Greece,Morocco,Malta,TurkiIsrael,Labanan,Tunisia Etc..

Diet vary between these countries and also between regions within a country,but there are some similarity in the dietery pattern they follow.life expectancy of people residing in mediterranian region are much higher compared to others.Moreover morbidity rate of cancer,Diabetis,Hypertension,coronary artery diseases and stroke are much less in this area.

DIETERY PATTERN….

Mediterranean" diet is not at all a vegetarian diet,but it is given importance to vegetables. It traditionally includes anti-oxidant rich fruits, green leafy vegetables, pasta, rice, olive oil and nuts.

..Olive oil is an important monounsaturated fat source
..Dairy products, fish and poultry are consumed fresh in low to moderate amounts,
..Little red meat is eaten.
..Eggs are consumed zero to four times a week
..Wine is consumed in low to moderate amounts
..Processed,tinned food are out of their menu
..Food stuff with artifical colours and preservervaties are avoided to a great extent

Relevance of Mediterranean diet

To study the association between Mediterranean diet and the risk of developing heart disease, researchers from Spain identified 1,224 older adults at a high risk of cardiovascular disease, 61 percent of whom had metabolic syndrome at the beginning of the study. The participants were divided into three groups- the first group was asked to have a Mediterranean diet with olive oil, the other was asked to have a Mediterranean diet with nuts and the third was advised to have a low fat diet.

Findings
It was found that those who followed a Mediterranean, with olive oil or nuts, had lower rates of metabolic syndrome

Further, the prevalence of metabolic syndrome among the men and women who followed the nut-enriched Mediterranean diet fell by nearly 14 percent over one year compared with roughly 7 percent among study participants who followed a traditional Mediterranean diet rich in olive oil.

On the other hand, in a third study group that followed a low-fat diet, the prevalence of metabolic syndrome dipped by only 2 percent.

Conclusion

The above findings suggest that the Mediterranean diet help to manage metabolic syndrome, even without weight loss or exercise. They also imply that the benefits may be greater when people use nuts as a major fat source.

Thursday, March 12, 2009

SUMMER AILMENTS

Common summer ailments and their solutions

For us, summer is the best time of the year. It brings memories of vacation,holiday trips etc.On the other hand, it is the usual time for all seasonal ailments ranging from heat stroke to water-borne diseases to vector borne-diseases.It's not only the heat that is making problem but also the high temperature ,that brings out many ailments. Lack of precautionary measures could make summer a nightmare

Prickly heat

Blocked sweat ducts force sweat into your skin causing an intense prickly, itchy rash, which keeps you awake at night .It may recur in the heat.It can make your holidays miserable

Solution
Keep you body as cool as possible, seek the shade, wear loose-fitting “breathable” fabrics and shower regularly

HOM: Aconite,bryonia,jaborandi,syzigium,led,sulphur (preferably6th potency ),urtica uresnsis etc according to indiactions

Sunstroke/dehydration

During summer season , the fluid intake is not able to meet the fluid loss from our body causing fluid imbalance which results in Malaise, headache, cramps, thirst, dry skin and small volumes of dark urine. Babies and the elderly are at risk of serious dehydration.

Solution
Keep your body cool and drink plenty of non-alcoholic fluids. But if you're feeling really ill with vomiting or drowsiness seek immediate medical advice

HOM: Bell,glonoine ,nat carb,aconite ,ver vir ,camphora etc. according to indication

Athlete's foot

Itchy, cracked skin between your toes. This may spread to the soles and sides of your feet.

Solutions

Dry your feet thoroughly after washing, and avoid shoes that make your feet sweat. Better still, leave your feet exposed as much as possible

HOM:Graphites and sanicula according to indication.

Insect bites and stings

Allergies to wasp or bee stings can be serious.Some people are allergic to the insect's saliva, and so develop a marked itchy reaction around the bite, with swelling or blistering. Allergies to wasp or bee stings can be serious.

Solutions

Cold compress is the best.
symptoms like swelling of your face, fingers,, difficulty in breathing would certaintly require immediate medical attention.

HOM: Apis,Hypericum,ledum,urtica urensis etc according to indication.

Swimmer's ear

It results from moistening your ears in pool or sea water, then baking them in sunshine.

solution

Keep water out of your ears; use earplugs when you swim. And don't be tempted to ease the symptoms by poking with a cotton bud as it will only make matters worse.

HOM :Puls,kali sulph,tellurium etc,according to indication.

Summer diarrhoea

Seen mainly among children below five, it sometimes takes epidemic proportions if not controlled. Unhygienic surroundings, overcrowded and contaminated places, and unclean vessels are mainly to blame. In summer, the water levels are low which leads to contamination of water.

Solutions

Fluid replacement is the key with frequent sips of water or rehydration fluids

Prevention is more important, so observe basic food hygiene rules.

HOM :Bry,camph,croton tig,china gambugia etc according to indication.

Health benefits of OATS

The common oat (Avena sativa) is a species of cereal grain . Oats suitable for human consumption as oatmeal and rolled oats.

•Oats absorb the extra fat and flush it out of the system,ie how they cure constipation.The rich fibre content helps to reduce the bad cholesterol.

•Diet rich in oats also help to stabilize blood glucose levels(Esp.Non Insulin Dependent Diabetis)

•Study in Boston university showed that meals with oats lowered blood pressure.

•It aids to cop with ovarian and uterine illiness largely associated with postmenopausal age,moreover mood swing among this group can be corrected with the help of regular oats meal.

•They are rich in Vitamin E ,antioxidants -in a way help to reduce the cell damage there by reduce the risk of cancer.

•Being a good source of calcium they are ideal for hair, nail and bone.

•US Food and drug administration announced that the fibre from oatmeal may reduce the risk of heart disease.

Nutritive value in 100 gms of oats when compared to wheat is much more ie.389 kcal ,19% more than wheat.It is an ingriediant in all most all baby foods.