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Haryana Medical Journal

Haryana Medical Journal

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The right action, with the right intent, in the right direction
This is what Lord Krishna, the divine physician teacher, explained to Arjuna on the battlefield of Kurukshetra.

This is what Haryana Medical Journal (HMJ), the official publication of Indian Medical Association Haryana Chapter, strives to do as well. Covering a wide spectrum of diagnostic and therapeutic sciences, HMJ publishes editorials, original articles, reviews, brief communications and case reports. These provide the reader with comprehensive coverage of contemporary as well as cutting edge medical science. HMJ has published manuscripts not only from Haryana and other states of India, but abroad as well.

Under the far sighted editorship of Dr Ashok Taneja (Gurgaon), supported by Associate Editors Dr. Kapil Midha and Dr. V. K. Gupta, HMJ has published special issues on Diabetes and Thyroid disorders. Both these conditions are now endemic to our state.

Haryana is known as the land where the first endocrine pharmaceutical supplement was invented. This was at Dhosi Hill, in Narnaul District, where the Raj Vaidyas, the Ashwin brothers, prepared Chyavan prash to rejuvenate the aging Rishi Chyavan.
In a similar manner, HMJ hopes to rejuvenate continuing (and current) medical education in the state, by providing its readers with an opportunity to expand, and revise, their information and knowledge.

At IMA Karnal, we feel privileged to host the e-version of HMJ from 2017 onwards. We feel humbled, yet proud, to fulfil the mandate of making our state journal accessible to a global audience. The open access model, with no user fee for either author or reader, helps in universal dissemination of medical knowledge. This, in turn, contributes to better clinical care and outcomes. In its small way, therefore, IMA Karnal hopes to be able to contribute to betterment of human health across the world.

With the right action and intent, we hope, HMJ readers, and IMA Karnal will be able to grow together, in the right direction.

Gagan Kaushal, President, IMA Karnal
Sanjay Kalra, Guest Editor, HMJ; IMA Karnal

Click here to access HMJ.

Sanjay Kalra

Sanjay Kalra

Consultant Endocrinologist at Bharti Hospital, Karnal
Dr. Sanjay Kalra, DM (AIIMS) works at Bharti Hospital, Karnal, in India. Associate Editor of Diabetic Medicine (UK), he handles numerous other editorial responsibilities, He is also Section Editor, Diabetes, of the Endocrine Society of India Manual of Clinical Endocrinology (1st and 2nd editions) and Section Editor, Endocrinology, of the Association of Physicians of India Textbook of Medicine, 11th edition. Vice-President of South Asian Federation of Endocrine Societies, he remains busy in clinical care, patient education, research and medical writing. He won the global DAWN Award for best translational research in diabetes in 2009. In his spare time, he finds time to indulge in his favorite hobby, the Punjabi folk dance bhangra.
Sanjay Kalra

Latest posts by Sanjay Kalra (see all)

Keeping Your Kidney Healthy

Keeping Your Kidney Healthy

Kidneys, Lifestyle

Kidney diseases are silent killers, which will largely affect your quality of life. There are however several easy ways to reduce the risk of developing kidney disease.

Keep fit and active – Keeping fit helps to reduce your blood pressure and therefore reduces the risk of Chronic Kidney Disease.The concept “on the move for kidney health” is a worldwide collective march involving the public, celebrities and professionals moving across a public area by walking, running and cycling. Why not join them – by whatever means you prefer!

Keep regular control of your blood sugar level – About half of people who have diabetes develop kidney damage, so it is important for people with diabetes to have regular tests to check their kidney functions.
Kidney damage from diabetes can be reduced or prevented if detected early. It is important to keep control of blood sugar levels.

Monitor your blood pressure – Although many people may be aware that high blood pressure can lead to a stroke or heart attack, few know that it is also the most common cause of kidney damage. High blood pressure is especially likely to cause kidney damage when associated with other factors like diabetes, high cholesterol and Cardio- Vascular Diseases. You should monitor your blood pressure level check regularly.

Eat healthy and keep your weight in check – This can help prevent diabetes, heart disease and other conditions associated with Chronic Kidney Disease.

Reduce your salt intake. The recommended sodium intake is 5-6 grams of salt per day (around a teaspoon). In order to reduce your salt intake, try and limit the amount of processed and restaurant food and do not add salt to food.

Maintain a healthy fluid intake – Although clinical studies have not reached an agreement on the ideal quantity of water and other fluids we should consume daily to maintain good health, traditional wisdom has long suggested drinking 2 to 3 liters of water per day.

Consuming plenty of fluid helps the kidneys clear sodium, urea and toxins from the body which, in turn, results in a “significantly lower risk” of developing chronic kidney disease.

Do not smoke – Smoking slows the flow of blood to the kidneys. When less blood reaches the kidneys, it impairs their ability to function properly. Smoking also increases the risk of kidney cancer by about 50 percent.

Do not take over-the-counter pills on a regular basis – Common drugs such non-steroidal anti-inflammatory drugs like ibuprofen are known to cause kidney damage and disease if taken regularly.

Get your kidney function checked if you have one or more of the ‘high risk’ factors – diabetes, hypertension, obese, your parents or other family members suffer from kidney disease.

Contributed by:

Dr. Dinesh Dhanda
DM Nephrology.

Madhumehika

Madhumehika

Diabetes, Lifestyle

Diabetes Education Forum (later changed to Foundation – DEF), Allahabad was founded in 2001 when it also launched its quarterly publication which was christened “Madhumehika” by our then Vice President and Patron, late Mr RN Srivastava.

Madhumehika is distributed free of cost to almost 7000 life members (and growing). It endeavours to educate and update the public about different aspects of diabetes using both Hindi and English. Each Madhumehika is theme based, pertaining to the previous camp conducted. Each largely attended quarterly camps focuses not only on diabetes – from lifestyle to self-monitoring to complications to nuances of insulin to hypoglycemia to diabetes in women, but also any situation that people with diabetes may encounter throughout their lifespan– from infections to hormone problems to ACS to organ transplantation to anesthesia and surgery to mental and social health. The theme for World Diabetes Day is always on a different note – whether it is organizing a play, hosting a fun-filled picnic, a rally, yoga camp or cultural program. Camps are held across the city, state and neighbouring states.

The key messages of Madhumehika are : for diabetics about empowerment through education on a continuum; for the general public to understand the serious impact of diabetes and know, where possible, how to avoid or delay diabetes and its complications.

The challenge is to keep the flow of articles coming, economic sustainability and postal hurdles. Its smooth delivery is ensured by the current editor Dr Shanti Chaudhri who is not only versatile, but irrepressible and irreplaceable.

Team DEF and Madhumehika work tirelessly in the battle to stop the onslaught of diabetes. You may read the magazine online at the below mentioned links.

Madhumehika Jan-Mar 2016

Madhumehika Apr-Jun 2016

Madhumehika July-Sep 2016

Madhumehika Oct-Dec 2016

Contributed by:

Dr Sarita Bajaj
MD (Medicine), DM (Endocrinology, AIIMS)
Director-Professor and Head, Dept of Medicine
MLN Medical College, Allahabad
President RSSDI (2016 onwards)
President API (UP Chapter 2016 onwards)

Dos and Donts during Ramadan fasting

Dos and Donts during Ramadan fasting

Diet, Lifestyle

Ramadan is the month of fasting and prayers for believers of Islam.

  • Fasting is obligatory for all adult, healthy Muslims.
  • During fasting, no food or water intake is permitted from dawn to dusk.

Who all are exempted:

  • Children below the puberty age
  • Mentally incapacitated individuals
  • People with acute illness
  • Chronic illness as diabetes with complications
  • While travelling for distances more than 50 miles
  • Menstruating women
  • Pregnant and breast feeding women

What are the Risks?

Category 1 – Subjects at very high risk – should preferably not fast

  • Episode of severe hypoglycaemia (assistance was needed for recovery) in the last 3 months
  • Recurrent hypoglycaemia
  • Hypoglycaemia unawareness
  • Sustained poor glycaemic control
  • Ketoacidosis in the previous three months
  • Type 1 Diabetes
  • Acute illness
  • Persons performing intense physical labour
  • Pregnancy
  • People on long term dialysis

Category 2 High risk

  • Average blood glucose between 150 – 300 mg/dl
  • Advanced complications as heart disease or paralysis
  • Living alone with treatment with insulin or sulfonylureas
  • Old age needing physical assistance
  • Mentally disabled persons

Category 3 – Moderate risk

  • People with a good blood glucose control on tablets liable to cause hypoglycaemia

Category 4- Low risk

  • People on a diet only
  • Treatment with metformin, acarbose, Tzds or incretin based therapy

 

What are the risks during fasting:

Hypoglycaemia (Low blood glucose < 60mg/dl)

Hyperglycaemia (High blood glucose > 300 mg/dl

DKA – decompensated diabetes which can be a threat to life

Dehydration and Thrombosis (clotting of blood in the vessels)

 

Preparation for Ramadan

  • Consult your physician 4 to 6 weeks before the onset of Ramadan
  • Achieve a good blood glucose control by following the recommended diet and adjustment of medication

Self Monitoring of Blood Glucose during fasting

  • 3 hours after the morning meal
  • One hour before Iftar
  • Mid Day for those on insulin or SU
  • Any time if hypo symptoms develop
  • Two to three hours after dinner

 

 

Diet in Ramadan:

  • Healthy and Balanced diet
  • Avoid large quantities of food and food rich in fats and refined carbohydrate ( sweets and sugary drinks)
  • Have more of complex carbohydrates specially in the morning meal. Use whole wheat Atta chapattis or cereal.
  • Take the pre-dawn meal as late as possible
  • DO NOT OVER EAT
  • Do not have the traditional fried food as pakoras and samosas
  • Have the evening meal at time of breaking the fast at sunset.
  • Follow with a snack at bedtime preferably a glass of milk
  • Drink plenty of water during the non-fasting hours.

Exercise

Strenous exercise should be avoided

Normal routine activity should be continued

Routine prayers and special prayers of Ramadan can be considered as the replacement  of daily exercise

Medication

The dosage of your tablets or insulin will be altered by your doctor

Keep the prescription handy for reference and follow the instructions.

If the blood glucose level is unusually high or low consult your doctor.

Rules for Breaking the fast:

  • If Blood glucose level reaches to less than 60mg/dl after noon
  • Blood glucose level is less than 70mg/dl a few hours after the morning meal and medication or insulin has been taken
  • Blood glucose exceeds 300mg/dl
  • Ketones in urine

 

Type 1 Diabetes and fasting     

Those who should not fast

  • High and unstable blood glucose levels.
  • Hypo unawareness,
  • Inability to perform home monitoring several times daily,
  • Limited access to medical care

Those who may fast

  • Stable patients,
  • Basal Bolus insulin regime is preferable (Short acting insulin before meals and a basal insulin for 24 hours stabilization).

 

FOLLOW THE RULES AND HAVE A PLEASANT AND ENJOYABLE RAMADAN. YOU WILL FEEL HEALTHIER AFTER 30 DAYS OF FASTING

Contributed by:

Dr. Fatema Jawad
Editor-in-chief,
Journal of Pakistan Medical Association, Karachi
Past President, PAME (Pakistan Association of Medical Editors)
Past Director WAME ( (World Association of Medical Editors) (2015-2017)
Consultant Diabetologist
Sindh Institute of Urology and Transplantation
Karachi, Palkistan

 

Eat Healthy Live Healthy

Eat Healthy Live Healthy

Diet, Lifestyle

Nutrition transition: The following dietary factors are associated with increase in NCDs like obesity, diabetes, hypertension and cardiovascular diseases.

  • Intergenerational variability in eating patterns
  • Family and social influences in eating patterns
  • Changing trends in dietary intake & cooking practices
  • Reduced consumption of fruits and vegetables
  • Increased consumption of processed and energy dense foods
  • Occupational variability
  • Changing lifestyle
  • Easy availability and feasibility of junk food
  • Education
  • Time constraints
  • TV viewing during meals

Healthy tips and Meal pattern for promoting healthier lifestyles

  • Adopt 6-7 small meal pattern instead of 2-3 major meals.
  • Eat at frequent intervals avoiding gaps (>3 hrs) in between meals.
  • Look for healthy eatables in-between major balanced meals.
  • Ensure balance meals comprising all the food groups
  • Drink at least 2-3 litres water/day.
  • Minimize intake of food items containing saturated fats (oil which hardens on standing), added sugars, salt and preservatives.
  • Opt healthy cooking methods such as baking, steaming, roasting, grilling, boiling over frying and oily preparations.

EATING IS MUST BUT NUTRITION IS NECESSITY

Way to choose healthy over unhealthy meals:

MEALS

THE HEALTHY WAY OUT

 

QUICK TO EAT…TOUGH TO  BURN
Breakfast mania

 

 

·              Whole grain cereal preparation like oats, porridge, poha, upma, idli, whole wheat bread, wheat flakes, muesli etc. combined with more and more of fresh vegetables

·              Balanced meals with more of seasonal vegetables, adequate cereals and lesser fats/oils

·              Low fat dairy products- milk, curd or paneer

·              Refined cereals like maida and maida products like rusk, fan, bakery biscuits, namkeens

·              Packed, preserved and ready-to-eat breakfast cereals

·              Full fat dairy products

Mid-morning Feast

 

·              Raw, fresh, seasonal and colourful fruit salad

·              Green tea/coffee without sugar

·              Juices and pureed fruits

·              Milk tea/coffee with sugar

Yummy Lunch Menu

 

·              Balanced home- made meals

·              Include cereals, pulses/non veg, vegetable preparation

·              Curd/raita/lassi/chacch

·              Lots of salads

·              Eating out

·              Readymade goodies

·              Oily preparations

Evening snacking munching

 

·              Dried nuts – 1 serving (7-8 pieces), veg chilla, roasted chana, vegetable sandwich

·              Non-vegetarian people can prefer egg whites or steamed/grilled/roasted/boiled/baked fish chicken, or lean meats

·              Sprouted chaat

·              Pizza, burger, chips, biscuits, mathis etc

·              Fatty and cholesterol rich muttons, organ meats, preserved meats, processed meats or packaged items.

Enjoy Dinner Nutrition

 

·              Usually eaten properly with family at home

·              Balanced meal similar to lunch

·              Eat at least 2-3 hours before going to bed

·              Outside food

·              Fried papads and chutneys

·              Heavy oily preparations

Post-dinner time

 

·              Plain milk to meet nutritional requirements of the day. ·              Oily and sugary sweet dishes

 

Too hot: Summer beverages ·              Soya milk

·              Coconut water

·              Fresh skimmed milk shakes

·              Lemon water, low fat dairy chaach/lassi

·              Home-made jaljeera with fresh coriander and mint

·              Cold drinks

·              Canned juices

·              Sugar containing drinks

·              Preserved & packed drinks

·              Alcohols

 

Sweet tooth Bite

 

·              Sweets made with less oil and sugar

·              Prepare low fat dairy items – oats kheer, fruit custard, phirni, vermicelli kheer

·              Less oily halwa

·              Add elaichi, kesar or nuts for taste and flavour

·              Oily and sugary sweet dish

·              Fried sweet dish

·              Gulab jamun, jalebi, rasgullas, sweet mathis

 

Weekly masti food choices

 

·              Prefer natural flavored dishes prepared with freshly used lemon, garlic, onion, elaichi, kesar, coriander, mint, other herbs and spices

·              Dhokla, khandvi, dosa, grilled aata bread sandwich, idli, steamed wheat momos, grilled paneer tikka

·              Avoid dishes with added pickles, chutneys, sauces, ketchups and creamy seasonings or mayonnaise

·              Bhaturas, puris, fried tikkis, french fries, pakoras, maida preparations

Physical activity ·              Use staircase

·              Outdoor activities

·              Running, jogging, cycling, skipping, dancing, aerobics, yoga

·              Elevators

·              Indoor activities

·              Screen time (playing video games, watching TV, computers, laptops, phones

Guest Post by Ms Lovely Gupta, Nutritionist and Dr Deepak Khandelwal, Endocrinologist, Maharaja Agrasen Hospital, Punjabi Bagh, New Delhi.

Skin Laser Hair Removal Made Simple

Skin Laser Hair Removal Made Simple

Lifestyle, Skin

1. Laser are useful for removing unwanted hair from various parts of body
2. Laser can selectively target dark, course hair while leaving the surrounding skin undamaged
3. Laser actually cause Permanent Hair “REDUCTION”, rather than “REMOVAL”.
4. If you are planning on undergoing laser hair removal, you should limit plucking, waxing, and electrolysis before treatment. That is because laser targets the hair roots, which are temporarily removed by plucking or waxing
5. Just before the procedure, your hair that will be undergoing treatment will be trimmed to a few millimeters above the skin surface
6. Depending on the laser light source used, you and the treating doctor may require appropriate eye protection
7. After the procedure, you may be given icepacks, anti- inflammatory creams and sunscreen location to ease the discomfort and avoid complications. The next session is scheduled 3-4 weeks later
8. On an average, the minimum sittings required for any area vary from 7-8. Maintenance frequency is decided by the treating doctor9. The cost of laser hair removal is decided according to-
– Size of area being treated
– Number of treatments required
– Part of the body where you are having the procedure.
10. Usually unwanted hair growth is associated with hormonal dysfunction. So, through investigations and expert opinion, preferably from an endocrinologist, is a must in such cases, for best outcomes.

Dr. Kiran Bajaj

Dr. Kiran Bajaj

MBBS from GOMCO,Patiala
M.D(Dermatology,Venereology, Leprology) from GGS MC,Faridkot (2002)
Senior Residency : PGIMS,Rohtak
Asstt Professor:Gian Sagar Medical College,Distt Patiala
Ex Skin specialist Civil Hospital, Karnal
Now practicing dermatocosmetologist in Karnal.Dr Kiran Bajaj Skin and Laser Centre, 7- B, , Duggal Colony,opposite KCGMC, Karnal .
Dr. Kiran Bajaj

Latest posts by Dr. Kiran Bajaj (see all)

Keeping Your Heart Healthy

Keeping Your Heart Healthy

Diet, Heart

The best way look after your heart is with a healthy lifestyle.

Be smoke-free
Being smoke free is one of the best things you can do to protect your heart.

Manage your blood cholesterol
Your body cholesterol needs to be healthy, but an imbalance of cholesterol in your blood can lead to a heart attack or stroke.

Manage your blood pressure
Blood pressure isn’t usually something you can feel. If it’s too high, it needs to be treated.

Manage diabetes
It’s important to manage your diabetes to help prevent a heart attack or stroke.

Be physically active
Regular, moderate physical activity is great for your heart health. It’s also important to sit less during your day and break up your sitting time.

Achieve and maintain a healthy weight
Maintaining a healthy weight can reduce the risk of heart disease and other health problems.

Enjoy a variety of nutritious foods
Eating a varied diet of healthy foods can help with your weight, blood pressure and cholesterol. There are also specific changes you can make to your diet to help prevent heart attack:
(a)Eat less salt: Reducing your salt intake is good for your blood pressure.
(b)Replacing unhealthy fats with healthy fats can reduce your risk of heart disease.

Look after your mental health
We know that there can be a greater risk of heart disease for people who have depression, are socially isolated or do not have good social support. Having a good social life with family and friends can help.

Source: American Heart Foundation

A Promise

A Promise

Lifestyle, Random

Perhaps the most illustrious son of Karnal, Maharishi Ved Vyas is created with writing the Mahabharata, the Upanishads and the Puranas. His name means ‘the one who classified or split the Vedas’, and made them easy for the public to understand. A temple dedicated to his worship still stands in village Basthali [ Vyassthal] near Nissing, and is testimony to Karnal District being his karam bhoomi.

 Modern medical science is a Mahabharata of its own, with multiple players enacting multiple roles. Physicians, paramedical staff and alternative medicine practitioners offer conflicting, and confusing health related advice to the public. This pandemonium is worsened by e-hearsay obtained from the net and social media. It is not unsurprising, therefore, that in spite of advances in both diagnostics and therapeutics, we consider ourselves less healthy as a society. The rapidly increasing burden of chronic metabolic disease which requires active participation of the patient, family and community, contributes to the pervasive feeling of societal ill-health.

IMA Karnal takes up the responsibility of providing accurate information to its community i.e, the people of Karnal, and Haryana. Through this blog, we will cover various aspects of health, and try to provide pragmatic advice related to preventive, curative and public health. In the footsteps of Rishi Ved Vyas, we hope to simplify and demystify disease, so as to make health achievable for all. We are known as Smart City Karnal. Let us work together to create a Health Smart City that we can be proud of.

Sanjay Kalra

Sanjay Kalra

Consultant Endocrinologist at Bharti Hospital, Karnal
Dr. Sanjay Kalra, DM (AIIMS) works at Bharti Hospital, Karnal, in India. Associate Editor of Diabetic Medicine (UK), he handles numerous other editorial responsibilities, He is also Section Editor, Diabetes, of the Endocrine Society of India Manual of Clinical Endocrinology (1st and 2nd editions) and Section Editor, Endocrinology, of the Association of Physicians of India Textbook of Medicine, 11th edition. Vice-President of South Asian Federation of Endocrine Societies, he remains busy in clinical care, patient education, research and medical writing. He won the global DAWN Award for best translational research in diabetes in 2009. In his spare time, he finds time to indulge in his favorite hobby, the Punjabi folk dance bhangra.
Sanjay Kalra

Latest posts by Sanjay Kalra (see all)

 

Deadly Thighs

Deadly Thighs

Exercise, Lifestyle

If you have a bit of junk in the trunk (belly fat), don’t worry — that lower body fat might help protect you from metabolic disease, Oxford University researchers found, because fat in the thighs and buttocks may have a protective effect. A Danish study even found that people with thin thighs have a greater risk of premature death. Maybe it’s better to have “thunder thighs” then thin “deadly thighs”!

Cheating can be good!

Cheating can be good!

Diet

What if we told you that you could cheat, guilt-free, and it would actually be good for you?

No, not the cheating in exams or love. We mean cheating on your diet, and chalking up some surprising benefits. On a weight loss diet, dietary cheaters invariably are successful. That happens because in response to a low calorie diet, the body slows downs the metabolism and burn less energy which is counterproductive to what you are trying to achieve. A cheat meal with extra calories helps to give a kick to the slowing down metabolism. Therefore it helps to not only ward off feeling of deprivation but keeps you on track with your dietary regimen. But be cautioned, don’t go overboard and keep the cheat meals to just once a week!