prediabetes http://www.telegraphindia.com/1161114/jsp/knowhow/story_118991.jsp

There has been an increase in the number of diabetic patients in India from 11.9 million in 1980 to 64.5 million. In fact, in the last 15 years, diabetes patients have increased by a 100 per cent. Also, 77.2 million people in India have pre-diabetes. They are not yet diabetic, but with fasting glucose levels in the 100 and 125mg/dL range, they have "impaired glucose tolerance" and are in real danger of eventually developing diabetes.

The pre-diabetic state was originally tested in people 35 and older, but now even preteens are developing impaired glucose tolerance. The explosion in the percentage of people with this condition has coincided with the popularity of cheap, calorie-dense, fast food; aerated, sugary, bottled drinks and home-based entertainment - from television, cell phones and computers - leading to sedentary or "couch potato" lifestyles.

Pre-diabetes is likely to be present at any age if:

♦ The BMI (weight divided by height in meter squared) is more than 25;

♦ The fat is concentrated around the abdomen;

♦ The lipid profile is abnormal;

♦ The blood pressure is above 140/90;

♦ There is a family history of diabetes;

♦ The skin on the folds of the neck and elbows is black and velvety in appearance, a condition known as "acanthosis nigricans";

♦ There are symptoms of increased fatigue, hunger, thirst and urination;

♦ If a woman have polycystic ovarian syndrome (PCOS) or diabetes during pregnancy or delivered a baby heavier than 4kg.

Anyone who exercises less than three days a week, and repeatedly has two consecutive days without physical activity may also become pre-diabetic.

After the age of 45, it is better to test for diabetes even if you are asymptomatic. If the sugar values are normal and there are no risk factors, the test should be repeated every three years. Children aged 10 and older should be tested for diabetes if they are overweight and have at least two risk factors.

To prevent pre-diabetes from becoming full-blown diabetes, maintain ideal body weight. This should be combined with regular exercise.

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CALCULATE YOUR SUGAR SCORE

• Age: If you are younger than 35, add 0 to your score
If you are between 35-49, add 20
If you are 50 or older, add 30

• Abdominal obesity: If waist size is less than 80cm (in women) or 90 (in men) add 0
If waist size is between 80-89 cm (in women) or 90-99 cm (in men), add 10 to your score
If waist size is more than 90 cm (women) or 100 cm (men), add 20 to your score

• Physical activity: If you exercise regularly and do strenuous work, add 0 to your score
If you either exercise regularly or do strenuous work, add 20
If you do not exercise and do sedentary work, add 30

• Family history: If there is no family history of diabetes, add 0
If one  parent is diabetic, add10
If both parents are diabetic, add 20

If your score is:
• >60: There is a very high risk of having diabetes
• 30-50: The risk of having diabetes is moderate. It is recommended you get blood tests done
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Source: Madras Diabetes Research Foundation, Chennai

Dr Gita Mathai is a paediatrician and author of StayingHealthy in Modern India. Mail your questions to yourhealthgm@yahoo.co.in

eczema

Don’t scratch that itch

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Your Health - Dr. Gita Mathai

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  Skin deep
  Keep eczema away
  
  Use a non-perfumed, moisturising soap. Apply lotion or oil after a bath. Add a tablespoon of coconut oil to the bathwater
  
  Apply mild steroid creams (only with a prescription) for relief. Avoid oral steroid medication
  
  For relief from scratching, take anti-allergy pills that do not make you sleepy
  
  Reduce stress with exercise, yoga and meditation

Eczema is a common skin condition, affecting 10-30 per cent of the population. The word is derived from Greek ekzein, which means ‘boil over, break out’. It is diagnosed when the skin is chronically inflamed in certain areas, with redness, itching and rash. The constant itching makes people scratch. Children are sometimes unable to reach the area, whereupon they rub it against clothing and available hard surfaces. The affected area may then begin to bleed or become secondarily infected. The skin can eventually become thickened and leathery.

The most common type of eczema is called “atopic dermatitis”. It starts in childhood. Affected children have close relatives with atopic dermatitis or other allergies such as constant sneezing. The attacks may be triggered by exposure to allergens in food such as cow’s milk, peanuts or food colouring. Contact with wool or synthetic fibres may aggravate the itching. Perfumes, soaps and detergents may also be precipitating factors.

Atopic dermatitis appears on the front or back of the knees, around the elbow, at the neck, on the scalp, hands or cheeks. It can appear as itchy dry red areas, which can eventually become discoloured. The itching can be severe enough to interfere with schoolwork, daily activities and disrupt sleep.

Infants fed on cow’s milk or formula can develop eczema because of cow’s milk protein. Sometimes rashes make their first appearance during weaning, when solid food like egg is introduced.

Most children grow out of their eczema. They start getting better around the age of one and are completely “cured” by the age of four.

Eczema may also be “contact eczema” where the reaction occurs only in areas in contact with the allergen. This is particularly common with nickel-plated artificial earrings or necklaces. Changing your brand of soap or shampoo can also precipitate a reaction. This type of eczema is easy to treat. Just removing the precipitating factor will make it clear up rapidly.

Sometimes the palms and soles of the feet are affected. Blisters form, the skin becomes rough and it may flake off. This is called dyshidrotic eczema.

Nummular or discoid dermatitis occurs in adults as oval-shaped patches, or blister-like sores. They occur on the arms, hands, feet and chest. They exude fluid, become scaly and can get secondarily infected.

Seborrhoeic dermatitis appears on the scalp (dandruff, cradle cap in infants), nose, around the umbilicus, sides of the nose, eye and skin folds under the breast. On the scalp, applying mineral oil, brushing away the flakes and then using an antidandruff shampoo usually clears the flakes.

Dr Gita Mathai is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India.

all work and no play

Play to the top, please

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Your Health - Dr. Gita Mathai

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My parents used to walk to school, a couple of kilometres both ways, in a chatty gaggle that built up a lifetime of friendships. Today's children take automated transport and barely have the time to talk for they are usually cramming - for unit tests, weekly exams or quarterly evaluations. They live and study in a pressure-cooker, their stress levels build up in junior school itself, and by the time they reach the public exams, many are not only physically unfit but may have reached breaking point. Many do not know how to study, or why they cannot recall what they have studied!

Schools contribute to this environment. The 11 o'clock and lunch breaks are reduced from the mandatory half and one hour. This means that children barely have time to gobble their lunch and go to the toilet (no time to play). The games period is usurped for extra classes. Weaker students are coached after school hours or sent to a tuition circuit. There is no time for hobbies, extracurricular activities or sports.

All this is counterproductive. Being a "topper" does not ensure admission to college and the ability to shine in your chosen career. For college, you only need to make the "cut off" grade and good grades do not ensure success in your career After five years, your school marks cease to be relevant. A child who has hobbies and plays a sport is more likely to be a well-rounded individual and be equipped with the character requirements for success.

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Children need to be physically active to cope with studies and the rigours of life. Unlike their inactive counterparts, they have a normal BMI (body mass index), lower body fat, are mentally sharper, and have better cardiovascular health. They tend to concentrate on studies and tasks better and grasp concepts faster. Their performance in reading and mathematics is demonstrably superior to their inactive counterparts.

Studies have shown that school-going children require an hour of physical activity. Since it is difficult to change the academic mindset, it becomes the responsibility of parents to try to ensure that this happens.

The exercise can be split into two or more segments but at the end of the day the minutes should have added up to an hour. It can be cycling, running, skipping, stair climbing, dancing or swimming. It requires parental involvement.

Parents may feel that taking a break for activity cuts into cramming time and is counterproductive. Actually, long study sessions without a break means that brain power is wasted trying to stay focused. The chemicals required for processing information become depleted. Periodic breaks allow chemicals to accumulate. Endorphins released from muscles during exercise boost this process. Adequate sleep is as important for efficient brain functioning. School going children require 8-11 hours of sleep.

Review of study sessions once or twice a few days apart, or even after a bout of physical activity are important to "grease" and establish brain pathways for efficient recall. Repeating the lesson loudly, reinforces the lesson through sight and sound.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Send questions on health to yourhealthgm@yahoo.co.in

D for Dumb

Dial D for Dumbness

http://www.telegraphindia.com/1160912/jsp/knowhow/story_107601.jsp

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Your Health - Dr. Gita Mathai

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Infants and toddlers who come to my clinic are often cranky. Instead of the old techniques of carrying them around, distracting them with toys, or my aquarium, today, more and more parents tackle these behaviour problems by immediately handing the child their smartphone. The child can barely walk or talk, but their podgy fingers swipe the screens expertly as they stare unblinkingly at the coloured images flashing on the screen. Parents think that this is a reflection of the intelligence of their toddler. This is far from the case. It is a disturbing and dangerous trend.

All electronic devices, cell phones, tabs or laptops emit MWR (micro wave radiation). Long-term exposure to this radiation is carcinogenic. There is still speculation about exactly how much radiation is safe, with conflicting reports and claims.

A child's thin skull bones allow greater penetration of MWR. His or her nervous system and brain tissue absorbs about two times more MWR than that of adults. His or her bone marrow absorbs ten times more radiation.

It is recommended that children under the age of two should not use cellphones at all. In all age groups, it is better to place cell phones a few inches away from the ear. They should be carried in backpacks or purses and not in pockets. In the case of laptops, computers and tablets, the minimum safe distance from the body is 20cm.

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Tablets are even more popular than cellphones as pacifiers for children. They have a larger variety of passive and interactive programs. The screen is larger (more radiation), it is also held closer to the face (brain). Children soon learn to video themselves. They replay their own videos in a narcissist fashion. This negates the need for friendship or social interaction. They become self absorbed, and since they are always in control of the happenings on the tab, they are unable to control their impulses. They do not interact with their peers or adults. Children learn and mature by watching adult social reactions to situations.

They become experts at swiping and tapping movements, usually with the dominant hand. Children constantly on these devices develop no dexterity or motor skills. They remain clumsy. They do not use their imagination to make believe and play. With no story telling or reading, lateral thinking, problem solving and the ability to learn maths and science are affected.

As the child becomes older, television replaces family interaction, play and even study time. Studies have documented that increased television viewing time delays and decreases development of language, vocabulary and social skills. Some imitate the exaggerated facial contortions and staccato speech of cartoon characters.

Children under two years of age should not watch television at all. Those older than 3 years who watched an hour or more a day were found to fare poorly academically. Their educational achievements by the age of 26 are behind those of their peers. This is because with television, everything is readily visible, and requires no analysis, reading or language skills. These areas of the brain lack stimulation and develop poorly.

There are educational programmes on television, specifically designed for children. These are seldom watched. Instead the focus is on mindless serials, and cartoons with unrealistic situations, which can desensitise the child to violence.

Dependence on media for entertainment leads to social isolation and regression of skills essential for survival and success. In addition, after school, homework, tuition and relaxation with television, there is no time physical exercise. This has led to an epidemic of unfit or obese children who develop lifestyle diseases in their twenties.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her atyourhealthgm@yahoo.co.in

ear aches

A pain in the ear

http://www.telegraphindia.com/1160905/jsp/knowhow/story_106287.jsp

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Your Health - Dr. Gita Mathai

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Earaches are what the word describes - a pain in the ear. What the word fails to convey is just how debilitating the attack can be. This is especially true in young children, whose inability to localise the discomfort can lead to prolonged, unexplained crying with fever.

The pain is most often due to a problem in the middle ear (otitis media). This is a small space with three bones (ossicles), the malleus, incus and stapes. The confined space is closed to the outside by the eardrum. Infections cause a build up of secretions (viral) and pus (bacterial), which is unable to escape. This causes excruciating pain. It can press on the ear drum, causing it to bulge. It can eventually burst, discharging the fluid.

The ear, nose and throat are all connected by the Eustachian tube that is situated behind the throat. An infection in any three can cause an earache. Allergies, or viral and bacterial infections can cause the nose to be blocked. In children the inner tonsil (adenoid) may become infected. This can swell, blocking the Eustachian tube.

In bottle-fed infants, milk can enter the Eustachian tube, which is shorter and straighter in infants. This can be caused by the infant sucking too rapidly from the bottle (unlike the breast where the flow is naturally regulated), lying flat while sucking (not at the recommended 45° angle), being put to sleep with a feeding bottle or holding the bottle and feeding themselves.

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Once infection sets in, there is fever and severe pain. The eardrum bulges and can be seen by physicians using an "otoscope". The child may be irritable and refuse to eat as any movement of the jaw aggravates the pain. There may even be temporary loss of hearing or balance. If the infection is not treated adequately and in time, it can recur or become chronic. It can even spread to the base of the brain.

The skin of the external ear canal can become infected because of excessive dampness caused by swimming, rain, allergies, eczema, or if the ear canal is damaged by hearing aids, buds, hairpins or even earphones.

The pinna of the external ear can get infected. This occurs in people who participate in contact sports such as wrestling and boxing, if small scratches occur to the ear or if the skin is pulled off. People may also have multiple ear piercings, with some holes being in the cartilage of the ear. Infection and damage can occur, especially if the procedure was unsterile. The infection can spread rapidly and affect the whole ear. It can become a bag of pus. Even if the pus is drained surgically, the ear may become deformed with multiple bumps forming a "cauliflower ear."

To prevent ear infections:

♦ Use a cup and spoon to feed children. If you must use a bottle, prop the child up at 45° angle. Do not use pacifiers.

♦ Yearly immunisation prevents flu, which predisposes children to ear infection. Common bacteria (Haemophilus influenza,
Streptococcus pneumoniae) which cause ear infection in children can also be prevented by immunisation.

♦ Avoid exposure to cigarette smoke. Even second hand smoke on hair and clothes precipitates infection.

♦ Do not damage the ear by placing foreign objects in it.

♦ Dry out the ear canal with a hair drier after swimming.

♦ If flying causes ear ache, use decongestant nose drops before boarding the flight.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

dengue

http://www.telegraphindia.com/1160822/jsp/knowhow/story_103646.

Banish the bite

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Your Health - Dr. Gita Mathai

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Mosquito borne diseases usually arrive with the monsoon. And this year is no exception; there is a resurgence of dengue. And it is we who are to blame. If each citizen took his or her social responsibility seriously, our country would not need to be a marked in red on the WHO maps for dengue!

The disease is spread by the Aedes egypti mosquito, an attractive insect, recognisable by its tiger striped legs (unlike the boring grey of the Culex and Anopheles mosquitoes). It is a friendly insect, which does not stray far from its place of birth. It loves humans and their environment. Unlike the dawn and dusk attacks of other mosquitoes, it bites in the daytime too. It is ferocious when it attacks its prey. One bite is not enough. It either attacks the person repeatedly or bites several human beings in the vicinity. That is why several members of the family can get dengue at the same time.

Four to 10 days after the bite, the affected person suddenly develops a fever. He or she may also suffer from a red rash, headache, pain behind the eyes, in the joints and the abdomen, nausea, vomiting and throat pain. At this stage, it is difficult to distinguish dengue from other fevers.

Within a few days, the white blood cell and platelet counts drop. The liver enzymes can start to rise. The person starts to develop antibodies to the virus which are are detectable in 50 per cent of patients by days 3-5 after onset of illness, and in 99 per cent by day 10.

Keep dengue away

• As little as 2ml of water is enough for mosquitoes to lay eggs. Check your immediate environment for garbage like old tires, bottle caps, even leaves. • Tanks and ponds should be stocked with small, larva-eating fish like guppies. • Pouring a little kerosene or oil on stagnant water creates a thin film on the surface that prevents larvae from breathing. • Put up mosquito-proofing nets on windows and ventilators. Keep doors shut. Sleep inside mosquito nets. • Application of mosquito repellents on clothing (not skin) is effective for a few hours. Patches (mosquito tattoos) contain pure citronella extract and can be placed on clothing. Equal volumes of vanilla extract and water applied on the skin repels mosquitoes for an hour.

A person usually recovers spontaneously from the first attack of dengue. Immunity develops to that particular strain of virus (there are four strains) and lasts for a lifetime. Unfortunately, if there is a subsequent attack of dengue (a different strain), the body's immune reaction produces a severe response.

Complications are more likely in patients under the age of 12 and over the age of 60 years. The white blood cell and platelet counts drop. This can lead to bleeding from various places. If the bleeding occurs in the brain, it can be fatal. The liver becomes enlarged and the liver enzymes elevated. As more toxins are released into the blood, the blood vessels become permeable. Fluid leaks out of the blood vessels and accumulates in the abdomen and in the lungs. The circulating plasma volume is reduced and shock may develop. Eventually, as organs like the liver, heart and kidney do not get enough blood, they can fail.

There are no antibiotics that cure dengue. Treatment is mainly supportive, to reduce the temperature, (paracetemol 10-15mg/kg per dose every 4-6 hours in children and 500mg in adults). Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids should be avoided.

Plenty of fluids should be given. In critically ill patients, admission to hospital and IV fluids and transfusions (of platelets) may be required. The exact criteria for platelet transfusion varies, and must be carefully done, as there is inherent risk associated with the transfusion of blood components.

There is as yet no vaccine against dengue. Ridding the house and its surroundings of the Aedes mosquito is the key to controlling dengue. Each individual needs to play a proactive role in this.

The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. If you have any questions on health issues please write toyourhealthgm@yahoo.co.in

breast milk

Best for baby

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Your Health - Dr. Gita Mathai

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Last week (August 1-7) was breast feeding week, and the entire world was involved in the great “latch on” — a word that best describes the way mammalian babies find their mothers and derive nutrition. Mothers gathered in public places and demonstrated that it was possible to breast feed babies, in public, discreetly and elegantly, and there was nothing “indecent” about it.

Breast feeding, though natural, is a failing art. It needs to be actively promoted, and not just for one week a year.

Breast milk is rich in fat and omega 3 fatty acids. It also contains the fat digesting enzyme lipase, so that all the fat is digested and absorbed. It also contains immunoglobulins (IgA), which protect the child against common viral, bacterial and gastrointestinal diseases. The composition and quantity of milk changes and regulates itself as the child grows older.

All mammals produce milk and the composition for each species is specific. Cow’s milk is best for calves and goat’s milk for kids. Human milk cannot be replicated in a factory, despite best efforts by the infant formula industry. The companies have tried various nutritious additives but it is not the “real thing.”

Manufacturers have tried to base the composition of formula milk on a human mother’s milk, analysed at approximately one to three months postpartum. Still, there are significant differences in the nutrient content of these products. For formula, purified cow’s milk, whey and casein are used as the  protein source, a blend of vegetable oils as the fat source and lactose for carbohydrates. Each manufacturer tries to add different vitamins and minerals to claim superiority over other products. None contain trace elements and immunoglobulins. It does not protect the child against disease. The fats are also not digested well and the stools of formula fed babies are foul smelling.

WHO (World Health Organization) recommends that infants  be exclusively breast fed for the first six months. To do this efficiently, the mother should be given a peaceful environment, an adequate diet and plenty of fluids. Drinking a glass of water before and after feeding ensures adequate flow of milk.

The baby has to search for the nipple, find it and latch on. Placing the nipple against the baby’s cheek can do this. Pushing the nipple into the mouth is counterproductive. The baby should be held at an angle of 45 degrees. Lying down and feeding the  baby is not a good idea.

Breast milk is always available on demand, it is sterile and at the right temperature. Our Indian clothes, with dupattas and sari pallus make breast feeding discreet.

The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. If you have any questions on health issues please write toyourhealthgm@yahoo.co.in·    

http://www.telegraphindia.com/1160815/jsp/knowhow/story_102445.jsp