10 steps to a long life
YOUR HEALTH
--------------------------------------------------------------------------------
DR GITA MATHAI
As we grow older and mature, the habit of reading the newspaper too grows. Everyday we find a wealth of information on health in newspapers, books and magazines, and wonder: what do we really need to do to stay fit?
1 Body weight
Body weight is a dynamic equation between the calories consumed and the level of activity. At all ages, we need to maintain our BMI (body mass index) — which is calculated by dividing the weight in kilograms by the height in metre squared — at 23.
Obesity (BMI over 30) is associated with a host of diseases like arthritis, diabetes, hypertension and cancer. It can be tackled by reducing the food intake and increasing the amount of exercise.
Being “size zero” with a BMI of 20 or less (underweight) may be fashionable if you are a model, but actually it’s a sign of ill health. It is associated with menstrual irregularities, poor pregnancy outcome and weak bones. Such a condition is often due to inadequate food intake. Correction of the diet will cause a weight gain. It may also be due to caries in the teeth, diabetes, thyroid problems, malabsorption, cancer and other chronic illnesses.
The number of calories needed a day varies from person to person. For weight loss it is 20 calories / kg, maintenance requires 30 calories / kg and for weight gain it is 40 calories / kg. These are approximate values and need to be adjusted according to activity levels.
2. Heart disease
Heart disease now affects men even in their thirties. Women are protected by their hormones till menopause. After that there is no difference between the sexes. You can take charge of your heart by not smoking as well as preventing exposure to second hand smoke. Include at least an hour of walking, jogging or running every day. Reduce stress with yoga or meditation.
3. Diet
The diet should be rich in vegetables, fruits, whole grains, fibre and fish (in the case of non-vegetarians). Snacking on readymade foods high in saturated fat and sodium is unhealthy.
4. Exercise
The current recommendations are an hour of aerobic activity like jogging, walking or swimming and 20 minutes of stretching or yoga every day.
5. The big C
Prevention and early detection of cancer can increase the lifespan considerably. Correct weight, regular exercise, a healthy diet, not smoking, and drinking in moderation contributes to the prevention of cancer. Hepatitis B immunisation protects against liver cancer, and HPV (human papillovirus virus) vaccine against cervical cancer. Regular “pap smear” tests, breast self examination and mammography detect cancers early in women. For men over 50, colonoscopy (in high-risk individuals) and PSA (prostate specific antigen) test should be regularly done.
6. Injuries
In India, over 80,000 persons die in road accidents annually, over 1.2 million get injured seriously and about 3,00,000 disabled permanently. Many motorbike accidents can be prevented if both the rider and pillion rider use crash helmets. While travelling in a car, everyone should use seat belts, not just on the highway but even for short distances within the city.
In the house, falls can occur on staircases and in bathrooms. These areas should be well lit. In addition, bars should be fixed in the toilet so that older people can grasp it firmly for support.
7. Master health checkups
A physical examination should be done every year, recording the height, weight, blood pressure, general condition of the heart, lungs and abdomen. The eyes and teeth should also be evaluated annually. Routine master health checkups offered by laboratories often have tests that are not required for a particular person. Some of the “package deals” may be unnecessarily expensive. It is best to go to your physician and do the tests you require. Some tests like haemoglobin, blood sugars and a lipid profile have to be repeated every year.
8. Chronic disease
If you have diabetes, kidney disease or some other chronic ailment, adhere to your diet and take your pills regularly. Keep all your follow-up appointments and do the blood tests on schedule. Complications of disease set in when patients are non-compliant.
9. Immunisations
Older people need influenza injections in September-October. The vaccine protects against the strain causing “flu” that year. When there is a pandemic (as there is this year of swine flu), that particular vaccine should also be taken. For those over 65, pneumococcal vaccine needs to be taken as a single dose.
10. Health supplements
Bone loss occurs in older people, in both men and women. Calcium supplements (around 1,200 mg a day) are needed to prevent this.
Tonics and protein supplements are not needed.
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
Monday, October 25, 2010
Saturday, October 9, 2010
stop dengue
Stop dengue in its tracks
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
India has had a good monsoon this year. Rivers are flooded and stagnant water can be seen everywhere. Urbanisation has resulted in a proliferation of improperly planned cities — with slums, and poor sanitation and sewage. This has provided mosquitoes with excellent breeding grounds. The population explosion in the insects has resulted in epidemics such as dengue.
Dengue fever is caused by the Aedes egypti mosquito. Culex and Anopheles mosquitoes (which cause diseases like malaria and filaria) are nocturnal — that is, they emerge and bite at night. They can be effectively kept at bay by using mosquito nets while sleeping at night. Aedes egypti, however, is a daytime urban insect. It cannot live above 1,220m or fly more than a hundred metres. It is easily identifiable — its body is striped like that of a tiger. It lives in houses and breeds in stagnant water. This could be in flower vases, old tyres, upturned bottle caps, and even water that collects on leaves and plants.
Eradication of their breeding grounds is, therefore, a Herculean task, which cannot be achieved by the government alone. Citizens need to do their bit, awaken their civic sense and keep their neighbourhood garbage free. At home, flower vases, water cooler trays, and all sorts of open containers — including broken mugs and bottle caps — should be emptied.
The government often uses “fogs” or sprays of insecticides to reduce the population of Aedes egypti in populated areas. The sprays need to be used every eight to 10 days to interrupt the cycle of virus transmission. Also, people must leave their doors and windows open so that the insecticide can penetrate indoors, into the nooks and crannies where the mosquitoes rest. We often close all openings to prevent the “harmful chemicals” from entering inside. This negates the effects of spraying.
Once an infected mosquito bites, there is an asymptomatic incubation period of five to six days. After this, dengue sets in abruptly with headache and high fever. There is pain behind the eyes and on moving the eyes. Severe body ache makes it difficult for the person to move, giving dengue the nickname “back breaking” fever. There may be rashes on the skin and inside the mouth. There may also be bleeding into the conjunctiva of the eyes, making them appear blood shot.
After three or four days, the temperature returns to normal. But this is only a temporary respite; the fever returns a few days later with all the previous symptoms but in a milder form. Dengue is, therefore, also called “saddle back” fever.
Unfortunately, there is no specific treatment for dengue. There is no vaccination (as yet) to prevent infection or specific antiviral medication to combat the condition. Affected persons have to ride out the disease with supportive treatment, hoping for the best. Treatment is symptomatic with paracetamol for lowering the fever and fluids for hydration. Aspirin and non-steroidal anti-inflammatory agents like brufen must be avoided. Blood transfusions may have to be given if there is bleeding and shock.
The first attack of dengue usually takes a few weeks to completely recover from. Overall, the disease has a five per cent mortality. It is especially dangerous in children. The dangerous form, called dengue haemorrhagic fever, which is accompanied by shock and bleeding, occurs with subsequent infections with the virus, especially if they are of a different “serotype”.
Humans are infective during the first three days when the virus is multiplying in the blood. During this period, it’s important they lie inside a mosquito net all day and night. This is to prevent them from infecting other members of the household.
The diagnosis is made by excluding other causes of fever. Blood tests may show a low white cell count and platelets. There are, however, some confirmatory tests, like complement fixation, Elisa and an increasing number of antibodies.
Dengue is a self-limited disease. The severity of the symptoms depends on the serotype of the virus, immunological status of the host and, to some extent, genetics.
Herbal products — such as fresh leaves and extracts of neem and tulasi — are being investigated for their anti viral and immune boosting properties. The results are not conclusive. Claims and counterclaims about the efficacy of herbal products are difficult to evaluate. Double blind control studies have not yet been done to prove or disprove their efficacy.
One can prevent mosquito bites to a certain extent by wearing long-sleeved clothing, sleeping inside a mosquito net, and using mosquito meshes for windows and doors. Water should not be allowed to stagnate in containers in and around residential areas. Adding a handful of rock salt or pouring kerosene into stagnant water prevents mosquitoes from breeding.
Remember, no vaccine or specific treatment exists — the only way to escape dengue is to prevent being stung by these pesky insects.
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
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
India has had a good monsoon this year. Rivers are flooded and stagnant water can be seen everywhere. Urbanisation has resulted in a proliferation of improperly planned cities — with slums, and poor sanitation and sewage. This has provided mosquitoes with excellent breeding grounds. The population explosion in the insects has resulted in epidemics such as dengue.
Dengue fever is caused by the Aedes egypti mosquito. Culex and Anopheles mosquitoes (which cause diseases like malaria and filaria) are nocturnal — that is, they emerge and bite at night. They can be effectively kept at bay by using mosquito nets while sleeping at night. Aedes egypti, however, is a daytime urban insect. It cannot live above 1,220m or fly more than a hundred metres. It is easily identifiable — its body is striped like that of a tiger. It lives in houses and breeds in stagnant water. This could be in flower vases, old tyres, upturned bottle caps, and even water that collects on leaves and plants.
Eradication of their breeding grounds is, therefore, a Herculean task, which cannot be achieved by the government alone. Citizens need to do their bit, awaken their civic sense and keep their neighbourhood garbage free. At home, flower vases, water cooler trays, and all sorts of open containers — including broken mugs and bottle caps — should be emptied.
The government often uses “fogs” or sprays of insecticides to reduce the population of Aedes egypti in populated areas. The sprays need to be used every eight to 10 days to interrupt the cycle of virus transmission. Also, people must leave their doors and windows open so that the insecticide can penetrate indoors, into the nooks and crannies where the mosquitoes rest. We often close all openings to prevent the “harmful chemicals” from entering inside. This negates the effects of spraying.
Once an infected mosquito bites, there is an asymptomatic incubation period of five to six days. After this, dengue sets in abruptly with headache and high fever. There is pain behind the eyes and on moving the eyes. Severe body ache makes it difficult for the person to move, giving dengue the nickname “back breaking” fever. There may be rashes on the skin and inside the mouth. There may also be bleeding into the conjunctiva of the eyes, making them appear blood shot.
After three or four days, the temperature returns to normal. But this is only a temporary respite; the fever returns a few days later with all the previous symptoms but in a milder form. Dengue is, therefore, also called “saddle back” fever.
Unfortunately, there is no specific treatment for dengue. There is no vaccination (as yet) to prevent infection or specific antiviral medication to combat the condition. Affected persons have to ride out the disease with supportive treatment, hoping for the best. Treatment is symptomatic with paracetamol for lowering the fever and fluids for hydration. Aspirin and non-steroidal anti-inflammatory agents like brufen must be avoided. Blood transfusions may have to be given if there is bleeding and shock.
The first attack of dengue usually takes a few weeks to completely recover from. Overall, the disease has a five per cent mortality. It is especially dangerous in children. The dangerous form, called dengue haemorrhagic fever, which is accompanied by shock and bleeding, occurs with subsequent infections with the virus, especially if they are of a different “serotype”.
Humans are infective during the first three days when the virus is multiplying in the blood. During this period, it’s important they lie inside a mosquito net all day and night. This is to prevent them from infecting other members of the household.
The diagnosis is made by excluding other causes of fever. Blood tests may show a low white cell count and platelets. There are, however, some confirmatory tests, like complement fixation, Elisa and an increasing number of antibodies.
Dengue is a self-limited disease. The severity of the symptoms depends on the serotype of the virus, immunological status of the host and, to some extent, genetics.
Herbal products — such as fresh leaves and extracts of neem and tulasi — are being investigated for their anti viral and immune boosting properties. The results are not conclusive. Claims and counterclaims about the efficacy of herbal products are difficult to evaluate. Double blind control studies have not yet been done to prove or disprove their efficacy.
One can prevent mosquito bites to a certain extent by wearing long-sleeved clothing, sleeping inside a mosquito net, and using mosquito meshes for windows and doors. Water should not be allowed to stagnate in containers in and around residential areas. Adding a handful of rock salt or pouring kerosene into stagnant water prevents mosquitoes from breeding.
Remember, no vaccine or specific treatment exists — the only way to escape dengue is to prevent being stung by these pesky insects.
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
Tuesday, September 28, 2010
hypertension
Don’t worry, get moving
YOUR HEALTH
DR GITA MATHAI
Hypertension or high blood pressure (BP) is like a thief who creeps in without warning in the dead of the night. That’s because the disease produces practically no symptoms.
People rarely develop giddiness, headaches or nose bleeds until the hypertension is very high. The first sign that there is something wrong may be a complication like a heart attack, stroke or ruptured aneurysm.
Blood pressure is optimal when it is 120/80 mmHg (millimetres of mercury) or less. It is considered normal even if it is 130/90 and high when it is 140/90 or more. Values of 130-140/85-99 are considered in the prehypertension category. Blood pressure needs to be monitored every two years after the age of 20 and yearly after 40.
Some kidney and adrenal gland diseases and diabetes can cause a rise in BP. It can also occur with certain medications like the oral contraceptive pill, some pain relieving medications and even decongestant cough syrups. Pregnancy may cause a peculiar type of hypertension called pre-eclampsia. In these patients, hypertension can revert to normal if the aggravating condition is tackled.
Doctors, too, can precipitate hypertension in normal people. The mere thought of a medical check-up and sight of the blood pressure apparatus can set the heart racing and blood pressure soaring. This is called “white coat hypertension”. If these people are monitored for 24 hours as they go about their daily activities, their BP is found to be normal. They do not require treatment.
Hypertension usually sets in during middle age. The exact reason is not known. Genes, the environment and upbringing count. Though it is not due to a single inherited gene, it’s more likely to occur if one or both parents are hypertensive.
Ideally, those with hypertension should monitor their BP at home to make sure it is under control. This way, they can immediately consult a doctor if it seems to be fluctuating or elevated. Wrist and cuff apparatuses are available that show automatic readings. The arm should be straight and on level with the heart while doing this.
Though a reading of 120/80 is ideal, doctors may set a target that is slightly higher in older people.
High BP should not be ignored. It must be treated and kept under control. Untreated, it makes the blood vessels thicken and less pliable. The blood supply to the brain is then affected. This can lead to loss of memory, balance, reasoning and other changes of dementia. It can cause a stroke with paralysis of parts of the body. The heart, unable to pump against high resistance, may fail or there may be a heart attack.
There are several groups of medicines to control hypertension. They should be taken exactly as advised. Timing is important – they pills should be swallowed as per schedule, even on fasts. They should not be taken in the morning one day and in the evening the next.
To prevent hypertension, and help lower the pressure once it has set in, the diet should have no high calorie snacks or junk food, be low in fat and dairy products, and rich in fruits and vegetables.
Fruits and nuts contain potassium and magnesium. The minerals balance the effect of sodium or salt in the diet. Salt causes the body to retain water and this elevates the BP. Salt consumption should be 2.5gm (1/2 tsp) per person a day. The “hidden salt” in aerated drinks, health supplements and preserved food should be taken into account. The taste for salt is developed at a very young age and depends on one’s cooking and eating habits.
A sedentary lifestyle results in a tendency to gain weight. The BMI (or body mass index — weight divided by height in metre squared) should be 23. Obesity (BMI greater than 30) increases the work of the heart and blood vessels. At least 40 to 60 minutes of active exercise should be incorporated into the every day schedule.
Tobacco in any form (gutkha, chewing tobacco, snuff, beedis and cigarettes) aggravates hypertension. When it comes to tobacco, there can be no halfway measures. Use has to be completely stopped. Alcohol, too, raises the BP. If you must drink, consumption should be limited to 60ml a day for men (two drinks) and 30ml a day for women.
Sustained stress, at home or in the workplace, also elevates the BP. Worry has never provided a solution to a problem. It just produces further problems. Exercise, deep breathing, yoga and meditation are good stress busters. Try them.
And for those who are not affected and want to remain that way, get up and get moving. Now.
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
YOUR HEALTH
DR GITA MATHAI
Hypertension or high blood pressure (BP) is like a thief who creeps in without warning in the dead of the night. That’s because the disease produces practically no symptoms.
People rarely develop giddiness, headaches or nose bleeds until the hypertension is very high. The first sign that there is something wrong may be a complication like a heart attack, stroke or ruptured aneurysm.
Blood pressure is optimal when it is 120/80 mmHg (millimetres of mercury) or less. It is considered normal even if it is 130/90 and high when it is 140/90 or more. Values of 130-140/85-99 are considered in the prehypertension category. Blood pressure needs to be monitored every two years after the age of 20 and yearly after 40.
Some kidney and adrenal gland diseases and diabetes can cause a rise in BP. It can also occur with certain medications like the oral contraceptive pill, some pain relieving medications and even decongestant cough syrups. Pregnancy may cause a peculiar type of hypertension called pre-eclampsia. In these patients, hypertension can revert to normal if the aggravating condition is tackled.
Doctors, too, can precipitate hypertension in normal people. The mere thought of a medical check-up and sight of the blood pressure apparatus can set the heart racing and blood pressure soaring. This is called “white coat hypertension”. If these people are monitored for 24 hours as they go about their daily activities, their BP is found to be normal. They do not require treatment.
Hypertension usually sets in during middle age. The exact reason is not known. Genes, the environment and upbringing count. Though it is not due to a single inherited gene, it’s more likely to occur if one or both parents are hypertensive.
Ideally, those with hypertension should monitor their BP at home to make sure it is under control. This way, they can immediately consult a doctor if it seems to be fluctuating or elevated. Wrist and cuff apparatuses are available that show automatic readings. The arm should be straight and on level with the heart while doing this.
Though a reading of 120/80 is ideal, doctors may set a target that is slightly higher in older people.
High BP should not be ignored. It must be treated and kept under control. Untreated, it makes the blood vessels thicken and less pliable. The blood supply to the brain is then affected. This can lead to loss of memory, balance, reasoning and other changes of dementia. It can cause a stroke with paralysis of parts of the body. The heart, unable to pump against high resistance, may fail or there may be a heart attack.
There are several groups of medicines to control hypertension. They should be taken exactly as advised. Timing is important – they pills should be swallowed as per schedule, even on fasts. They should not be taken in the morning one day and in the evening the next.
To prevent hypertension, and help lower the pressure once it has set in, the diet should have no high calorie snacks or junk food, be low in fat and dairy products, and rich in fruits and vegetables.
Fruits and nuts contain potassium and magnesium. The minerals balance the effect of sodium or salt in the diet. Salt causes the body to retain water and this elevates the BP. Salt consumption should be 2.5gm (1/2 tsp) per person a day. The “hidden salt” in aerated drinks, health supplements and preserved food should be taken into account. The taste for salt is developed at a very young age and depends on one’s cooking and eating habits.
A sedentary lifestyle results in a tendency to gain weight. The BMI (or body mass index — weight divided by height in metre squared) should be 23. Obesity (BMI greater than 30) increases the work of the heart and blood vessels. At least 40 to 60 minutes of active exercise should be incorporated into the every day schedule.
Tobacco in any form (gutkha, chewing tobacco, snuff, beedis and cigarettes) aggravates hypertension. When it comes to tobacco, there can be no halfway measures. Use has to be completely stopped. Alcohol, too, raises the BP. If you must drink, consumption should be limited to 60ml a day for men (two drinks) and 30ml a day for women.
Sustained stress, at home or in the workplace, also elevates the BP. Worry has never provided a solution to a problem. It just produces further problems. Exercise, deep breathing, yoga and meditation are good stress busters. Try them.
And for those who are not affected and want to remain that way, get up and get moving. Now.
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
Tuesday, September 14, 2010
fit treatment
Fit treatment
YOUR HEALTH
--------------------------------------------------------------------------------
DR GITA MATHAI
The child stared into space grimacing at bystanders. “Stop it,” said the mother, embarrassed by the responses her actions evoked. But the child ignored her, then blinked and followed her obediently. Nobody realised that the little girl had just suffered a fit of atypical epileptic seizure.
In classical epilepsy, typically, there is a cry followed by rolling up of the eyes and uncontrolled repetitive thrashing of the arms and legs. It usually lasts a few minutes after which the person falls to the ground. There may be no recollection of the event later.
To the untutored bystander, it may appear that the person has lost control of his or her body and been possessed by some “demonic force”. This is why the illness is called epilepsy, from the Greek word “seized”. But epilepsy actually occurs because of sudden unregulated rapid electrical discharges in the brain. It has nothing to do with demons, and exorcism will not help.
All seizures are not the same. Only one half the body, or even just a part — like the arms or face — may be affected. The rapid movements may resemble an uncontrolled tic or twitch. A sudden temporary interruption in the electrical pathways may affect consciousness, awareness, movements or bodily posture. This can result in unfocused staring (absence attacks), or “feelings” of jamais vu (unreality) or déjà vu (familiarity), or disturbances in vision, hearing and balance. In children, the seizures may be even more atypical. The child may just stare inattentively and blankly for a few minutes, suddenly fall forward, or start nodding.
About 2 per cent of adults have a seizure at some time in their life. Often, it is a one-off occurrence. Children are more prone to seizures, particularly when the temperature rises. Such “febrile seizures” occur during an episode of fever, in 3 to 4 per cent of otherwise normal children from the age of nine months to five years. This may recur three or four times during subsequent episodes of fever.
A person is labelled as suffering from a seizure disorder or is an “epileptic” if there have been two or more episodes in the preceding six months, without an obvious precipitating cause. Seizures can occur if:
There is a genetic predisposition (around 30 per cent of epileptics have a close relative with seizures)
The brain structure is abnormal, producing alterations in the electrical pathway. These may be developmental or acquired as a result of trauma or surgery
The person has infections of the brain like encephalitis, meningitis or abscess
There are brain tumours
There is excessive alcohol consumption or sudden withdrawal
The person uses illegal recreational drugs
There are biochemical abnormalities like low blood sugars and other metabolic or electrolyte imbalances
There are disturbances in the blood supply to the brain.
The condition may also be precipitated by physical factors such as flickering lights, sleep deprivation or music.
Seizures are investigated with blood tests, electroencephalogram (EEG), computed tomography (CT) scan and / or magnetic resonance imaging (MRI).
Seizure disorders require regular treatment with medications. These have negligible side effects and most can be taken safely during pregnancy as well. With the patient’s compliance, and correct and adequate medication, seizures are well controlled in 75 per cent of sufferers.
After regular treatment for three to five years, the medications are usually tapered off under supervision. Medication should never be abruptly discontinued or doses missed.
People with seizures can lead normal lives. Their academic performance need not suffer if the disease is managed well. However, driving, operating heavy machinery or working in areas with loud music or flickering lights should be avoided.
In women with epilepsy, fluctuating levels of natural hormones during the course of a normal menstrual cycle can cause an increase in the incidence and frequency of epileptic attacks premenstrually. Fertility is not affected by seizures.
Seizure medications (with the exception of sodium valporate) reduce the efficacy of oral contraceptives. Women with epilepsy who wish to practise contraception need a combination pill containing at least 50 mg of oestrogen. But instead of these higher dose pills, barrier contraception — such as condoms and diaphragms, or an IUCD (intra uterine contraceptive device like copper T) — may be a better option.
During pregnancy, good seizure control should be achieved for the safety of both the baby and mother. The overall risk of birth defects in epileptic women is around 7 per cent as against 3 per cent in the general population. If a woman is planning to become pregnant, she should immediately start folic acid supplements (5mg a day). Folic acid has a protective effect on the baby’s brain and spinal cord development in the first 40 days after conception.
Epilepsy is not a contraindication to breast-feeding, although small amounts of medication do cross over to breast milk. Epileptics can lead normal and productive lives if the condition is adequately controlled with proper medication.
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
YOUR HEALTH
--------------------------------------------------------------------------------
DR GITA MATHAI
The child stared into space grimacing at bystanders. “Stop it,” said the mother, embarrassed by the responses her actions evoked. But the child ignored her, then blinked and followed her obediently. Nobody realised that the little girl had just suffered a fit of atypical epileptic seizure.
In classical epilepsy, typically, there is a cry followed by rolling up of the eyes and uncontrolled repetitive thrashing of the arms and legs. It usually lasts a few minutes after which the person falls to the ground. There may be no recollection of the event later.
To the untutored bystander, it may appear that the person has lost control of his or her body and been possessed by some “demonic force”. This is why the illness is called epilepsy, from the Greek word “seized”. But epilepsy actually occurs because of sudden unregulated rapid electrical discharges in the brain. It has nothing to do with demons, and exorcism will not help.
All seizures are not the same. Only one half the body, or even just a part — like the arms or face — may be affected. The rapid movements may resemble an uncontrolled tic or twitch. A sudden temporary interruption in the electrical pathways may affect consciousness, awareness, movements or bodily posture. This can result in unfocused staring (absence attacks), or “feelings” of jamais vu (unreality) or déjà vu (familiarity), or disturbances in vision, hearing and balance. In children, the seizures may be even more atypical. The child may just stare inattentively and blankly for a few minutes, suddenly fall forward, or start nodding.
About 2 per cent of adults have a seizure at some time in their life. Often, it is a one-off occurrence. Children are more prone to seizures, particularly when the temperature rises. Such “febrile seizures” occur during an episode of fever, in 3 to 4 per cent of otherwise normal children from the age of nine months to five years. This may recur three or four times during subsequent episodes of fever.
A person is labelled as suffering from a seizure disorder or is an “epileptic” if there have been two or more episodes in the preceding six months, without an obvious precipitating cause. Seizures can occur if:
There is a genetic predisposition (around 30 per cent of epileptics have a close relative with seizures)
The brain structure is abnormal, producing alterations in the electrical pathway. These may be developmental or acquired as a result of trauma or surgery
The person has infections of the brain like encephalitis, meningitis or abscess
There are brain tumours
There is excessive alcohol consumption or sudden withdrawal
The person uses illegal recreational drugs
There are biochemical abnormalities like low blood sugars and other metabolic or electrolyte imbalances
There are disturbances in the blood supply to the brain.
The condition may also be precipitated by physical factors such as flickering lights, sleep deprivation or music.
Seizures are investigated with blood tests, electroencephalogram (EEG), computed tomography (CT) scan and / or magnetic resonance imaging (MRI).
Seizure disorders require regular treatment with medications. These have negligible side effects and most can be taken safely during pregnancy as well. With the patient’s compliance, and correct and adequate medication, seizures are well controlled in 75 per cent of sufferers.
After regular treatment for three to five years, the medications are usually tapered off under supervision. Medication should never be abruptly discontinued or doses missed.
People with seizures can lead normal lives. Their academic performance need not suffer if the disease is managed well. However, driving, operating heavy machinery or working in areas with loud music or flickering lights should be avoided.
In women with epilepsy, fluctuating levels of natural hormones during the course of a normal menstrual cycle can cause an increase in the incidence and frequency of epileptic attacks premenstrually. Fertility is not affected by seizures.
Seizure medications (with the exception of sodium valporate) reduce the efficacy of oral contraceptives. Women with epilepsy who wish to practise contraception need a combination pill containing at least 50 mg of oestrogen. But instead of these higher dose pills, barrier contraception — such as condoms and diaphragms, or an IUCD (intra uterine contraceptive device like copper T) — may be a better option.
During pregnancy, good seizure control should be achieved for the safety of both the baby and mother. The overall risk of birth defects in epileptic women is around 7 per cent as against 3 per cent in the general population. If a woman is planning to become pregnant, she should immediately start folic acid supplements (5mg a day). Folic acid has a protective effect on the baby’s brain and spinal cord development in the first 40 days after conception.
Epilepsy is not a contraindication to breast-feeding, although small amounts of medication do cross over to breast milk. Epileptics can lead normal and productive lives if the condition is adequately controlled with proper medication.
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
Tuesday, September 7, 2010
running for life
Run for your life
YOUR HEALTH
--------------------------------------------------------------------------------
DR GITA MATHAI
Fauja Singh (in foreground) shows no signs of slowing down even at 99
Last Sunday, when most of you had probably just woken up, I was running the Chennai half marathon with around 8,000 others. For me, a 58-year-old grandmother, age is certainly no bar. The only constraints are the few male louts on the road who stare, pass comments or snigger.
Children run simply for the joy of it, but in older individuals regular running confers specific health benefits. And all you need is a pair of shoes and socks.
Running (not walking) is one of the easiest ways to lose weight. An hour of this activity uses up around 500 calories. A negative balance of 3,500 calories results in loss of half a kilogram. The body metabolism also perks up, becoming more efficient. What’s more, the calories burnt while resting also increase. If running is combined with a sensible diet, appreciable changes can be seen in the weight and shape of your body in a month.
While running, the blood vessels expand and contract at three times their normal rate. This improves circulation, lowers blood pressure and reduces the risk of a stroke and heart attacks.
No one wants to look old. When you run, the muscles and bones are activated. This strengthens them, reducing the risk of weakness and osteoporosis. Running makes you fit and look young without the side effects of plastic surgery and botox.
Everyone would like to be happy all the time. Since mood-elevating drugs are illegal, and alcohol is not advisable, the easiest way to achieve this is to get a “runner’s high”. Mood elevating endorphins are released while running. Around 40-45 minutes of running elevates the mood and prevents depression for the whole day.
While running, the individual has to focus on the road, forgetting the problems of home and work. This relieves stress.
In students, running increases concentration and gives a feeling of accomplishment. Running does not reduce the time available for studies. On the contrary, it freshens the mind and builds stamina. An athletic student can study more effectively than a sedentary one.
While running we often find that roads are uneven with rocks, potholes and other hazards. Concentration, co-ordination and balance improve as a runner negotiates these obstacles. The person develops excellent control over his or her body.
The improved blood supply to the heart and lungs makes runners less prone to infections and illnesses. Even when illness strikes, recovery is quick.
People often fear that runners suffer more knee and hip injuries than others. This, however, is a myth. To get the maximum benefit from running with minimum injury, the muscles should be warmed up with a few stretches and five minutes of slow walking. Also, attention should be paid to increasing the body’s core strength. This can be achieved by doing push ups and holding the “plank” pose.
For those who have not run for many years, there are several techniques to get started. The “10 steps walk 10 steps run” routine is simple. After a week, you can increase to 20 steps run and 10 steps walk. Eventually, over a period of time, you can run the entire hour.
Couples can sometimes be seen walking in the mornings. The man is properly attired in track pants or shorts with shoes. But the woman is often seen struggling, thanks to her voluminous sari and chappals. It is better to wear a salwar kameez or track pants. You need not worry about derogatory comments from neighbours and passers by. As your health improves by leaps and bounds, diabetes and hypertension get controlled, and depression lifts, you will cease to care about popular opinion.
Shoes are important. The soles should be supportive and fitted properly. Repeated impact on the hard ground can cause heel pain, especially in an overweight individual. Slippers are dangerous as the feet can slip out while walking fast. The slipper keeps hitting the back of the heel. This isn’t very comfortable and can result in injury.
Age is considered a deterrent to running, again a fact proven wrong by the oldest marathon runner (distance: 42km) Fauja Singh (born 1911). He started running at the age of 63 and shows no signs of slowing down even at 99. The oldest female marathoner is Ida Mintz who ran till she died at the age of 85. She started running at the age of 73.
So forget all ifs and buts and start moving. Run towards health and happiness.
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
YOUR HEALTH
--------------------------------------------------------------------------------
DR GITA MATHAI
Fauja Singh (in foreground) shows no signs of slowing down even at 99
Last Sunday, when most of you had probably just woken up, I was running the Chennai half marathon with around 8,000 others. For me, a 58-year-old grandmother, age is certainly no bar. The only constraints are the few male louts on the road who stare, pass comments or snigger.
Children run simply for the joy of it, but in older individuals regular running confers specific health benefits. And all you need is a pair of shoes and socks.
Running (not walking) is one of the easiest ways to lose weight. An hour of this activity uses up around 500 calories. A negative balance of 3,500 calories results in loss of half a kilogram. The body metabolism also perks up, becoming more efficient. What’s more, the calories burnt while resting also increase. If running is combined with a sensible diet, appreciable changes can be seen in the weight and shape of your body in a month.
While running, the blood vessels expand and contract at three times their normal rate. This improves circulation, lowers blood pressure and reduces the risk of a stroke and heart attacks.
No one wants to look old. When you run, the muscles and bones are activated. This strengthens them, reducing the risk of weakness and osteoporosis. Running makes you fit and look young without the side effects of plastic surgery and botox.
Everyone would like to be happy all the time. Since mood-elevating drugs are illegal, and alcohol is not advisable, the easiest way to achieve this is to get a “runner’s high”. Mood elevating endorphins are released while running. Around 40-45 minutes of running elevates the mood and prevents depression for the whole day.
While running, the individual has to focus on the road, forgetting the problems of home and work. This relieves stress.
In students, running increases concentration and gives a feeling of accomplishment. Running does not reduce the time available for studies. On the contrary, it freshens the mind and builds stamina. An athletic student can study more effectively than a sedentary one.
While running we often find that roads are uneven with rocks, potholes and other hazards. Concentration, co-ordination and balance improve as a runner negotiates these obstacles. The person develops excellent control over his or her body.
The improved blood supply to the heart and lungs makes runners less prone to infections and illnesses. Even when illness strikes, recovery is quick.
People often fear that runners suffer more knee and hip injuries than others. This, however, is a myth. To get the maximum benefit from running with minimum injury, the muscles should be warmed up with a few stretches and five minutes of slow walking. Also, attention should be paid to increasing the body’s core strength. This can be achieved by doing push ups and holding the “plank” pose.
For those who have not run for many years, there are several techniques to get started. The “10 steps walk 10 steps run” routine is simple. After a week, you can increase to 20 steps run and 10 steps walk. Eventually, over a period of time, you can run the entire hour.
Couples can sometimes be seen walking in the mornings. The man is properly attired in track pants or shorts with shoes. But the woman is often seen struggling, thanks to her voluminous sari and chappals. It is better to wear a salwar kameez or track pants. You need not worry about derogatory comments from neighbours and passers by. As your health improves by leaps and bounds, diabetes and hypertension get controlled, and depression lifts, you will cease to care about popular opinion.
Shoes are important. The soles should be supportive and fitted properly. Repeated impact on the hard ground can cause heel pain, especially in an overweight individual. Slippers are dangerous as the feet can slip out while walking fast. The slipper keeps hitting the back of the heel. This isn’t very comfortable and can result in injury.
Age is considered a deterrent to running, again a fact proven wrong by the oldest marathon runner (distance: 42km) Fauja Singh (born 1911). He started running at the age of 63 and shows no signs of slowing down even at 99. The oldest female marathoner is Ida Mintz who ran till she died at the age of 85. She started running at the age of 73.
So forget all ifs and buts and start moving. Run towards health and happiness.
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
Friday, August 27, 2010
superbug made in india
he media have been full of stories about the “super bug from India”. The bug is actually a single-celled bacteria belonging to the Eschericia coli (E. coli) family. The species carries an enzyme called New Delhi metallo-beta—lactamase (NDM-1), which allows it to neutralise all known antibiotics and survive in their presence.
The enzyme was first isolated from a patient who had come to India for elective surgery. When he left, he took the “super bug” with him. No one knows how prevalent the organism is in India, as we do not have a centralised surveillance and reporting system that tracks hospital acquired infections and bacterial antibiotic resistance patterns.
Resistance is not a new phenomenon. Sulpha drugs and penicillin — the first antibiotics — were once hailed as “miracle” drugs. Today, they are hardly used. Overuse and misuse resulted in almost all bacteria becoming resistant to them.
If appropriate antibiotics are administered during a disease process caused by bacteria, the germs die. The host develops antibodies that help the body eliminate the weakened organisms.
E. coli has been around for thousands of years. That’s because the microorganisms developed “plasmids”, stable genetic elements composed of DNA or RNA. These help the bacteria grow resistance to chemicals and antibiotics. Once they have acquired this ability, they pass on the gene to other bacteria, even belonging to different species. Staphylococcus aureus and Klebsiella too have developed multiple drug resistance.
The outbreak of plague in Gujarat in 1994 killed hundreds. The state government realised the disease could be controlled by preventing rats from infesting human habitation and with appropriate antibiotic treatment. The situation was thus brought under control.
The spread of antibiotic resistance too can be controlled with combined concentrated effort. People are often “too busy” to consult a doctor when they are ill. The neighbourhood pharmacy then seems an attractive alternative. The man at the counter (often not a qualified pharmacist) dispenses antibiotics for coughs, colds, fever and diarrhoea. But there is often no rational or appropriate use of antibiotics.
Also, people sometimes do not complete the full course of a drug. They keep a few tablets, popping them for similar symptoms later or dispensing them to friends and relatives. A single dose may temporarily suppress the symptom. In a previously healthy person, the body’s natural defences then take over and eliminate the bacteria. The elderly or those with poor immunity become sicker, requiring the services of a qualified doctor. The bacteria, meanwhile, thrives in the presence of the antibiotic, because either they were not susceptible or the dosage was too small to be effective. Antibiotic resistance develops.
Practitioners of alternative systems of medicine prescribe and dispense antibiotics (which they are not licensed to use) inappropriately, perpetuating the problem.
At times, qualified physicians and surgeons use antibiotics prophylactically, especially after surgical procedures, to “prevent infection”. These antibiotics are eventually excreted by the body. They reach the sewage systems and seep through the earth. Bacteria are naturally present in sewage. They spread and multiply in the presence of the antibiotic.
Cattle and poultry feed are laced with antibiotics to “prevent” infection. Antibiotic resistant bacteria thrive on farms.
Everyone must play his or her part well to prevent another plague with super bugs which places the entire world population at risk.
• Take treatment only from qualified physicians
• Always buy antibiotics with a prescription, not OTC
• Complete the course in the dosage prescribed
Hygiene has to be maintained not just in the hospitals but also at home. Regularly washing hands, an elementary procedure, reduces infection and its spread.
Governments, nationally and internationally, need to maintain surveillance to monitor emerging infections and drug resistance patterns. If everyone — patients, doctors and the public — does not co-operate on a war footing, we may revert to the dark ages of the pre penicillin era. No antibiotic will work against infections and developing an infectious disease will turn out to be a death sentence.
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
The enzyme was first isolated from a patient who had come to India for elective surgery. When he left, he took the “super bug” with him. No one knows how prevalent the organism is in India, as we do not have a centralised surveillance and reporting system that tracks hospital acquired infections and bacterial antibiotic resistance patterns.
Resistance is not a new phenomenon. Sulpha drugs and penicillin — the first antibiotics — were once hailed as “miracle” drugs. Today, they are hardly used. Overuse and misuse resulted in almost all bacteria becoming resistant to them.
If appropriate antibiotics are administered during a disease process caused by bacteria, the germs die. The host develops antibodies that help the body eliminate the weakened organisms.
E. coli has been around for thousands of years. That’s because the microorganisms developed “plasmids”, stable genetic elements composed of DNA or RNA. These help the bacteria grow resistance to chemicals and antibiotics. Once they have acquired this ability, they pass on the gene to other bacteria, even belonging to different species. Staphylococcus aureus and Klebsiella too have developed multiple drug resistance.
The outbreak of plague in Gujarat in 1994 killed hundreds. The state government realised the disease could be controlled by preventing rats from infesting human habitation and with appropriate antibiotic treatment. The situation was thus brought under control.
The spread of antibiotic resistance too can be controlled with combined concentrated effort. People are often “too busy” to consult a doctor when they are ill. The neighbourhood pharmacy then seems an attractive alternative. The man at the counter (often not a qualified pharmacist) dispenses antibiotics for coughs, colds, fever and diarrhoea. But there is often no rational or appropriate use of antibiotics.
Also, people sometimes do not complete the full course of a drug. They keep a few tablets, popping them for similar symptoms later or dispensing them to friends and relatives. A single dose may temporarily suppress the symptom. In a previously healthy person, the body’s natural defences then take over and eliminate the bacteria. The elderly or those with poor immunity become sicker, requiring the services of a qualified doctor. The bacteria, meanwhile, thrives in the presence of the antibiotic, because either they were not susceptible or the dosage was too small to be effective. Antibiotic resistance develops.
Practitioners of alternative systems of medicine prescribe and dispense antibiotics (which they are not licensed to use) inappropriately, perpetuating the problem.
At times, qualified physicians and surgeons use antibiotics prophylactically, especially after surgical procedures, to “prevent infection”. These antibiotics are eventually excreted by the body. They reach the sewage systems and seep through the earth. Bacteria are naturally present in sewage. They spread and multiply in the presence of the antibiotic.
Cattle and poultry feed are laced with antibiotics to “prevent” infection. Antibiotic resistant bacteria thrive on farms.
Everyone must play his or her part well to prevent another plague with super bugs which places the entire world population at risk.
• Take treatment only from qualified physicians
• Always buy antibiotics with a prescription, not OTC
• Complete the course in the dosage prescribed
Hygiene has to be maintained not just in the hospitals but also at home. Regularly washing hands, an elementary procedure, reduces infection and its spread.
Governments, nationally and internationally, need to maintain surveillance to monitor emerging infections and drug resistance patterns. If everyone — patients, doctors and the public — does not co-operate on a war footing, we may revert to the dark ages of the pre penicillin era. No antibiotic will work against infections and developing an infectious disease will turn out to be a death sentence.
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
Wednesday, August 11, 2010
work out for well being
Work out your well-being
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
Recently, there was some media hype about the so-called negative effects of exercise and suggestions that it could actually be detrimental to health. Many couch potatoes jumped on the bandwagon, proclaiming they had been right all along — that their kind of sedentary lifestyle was preferable and healthier than an active one.
But what the article in question actually said was that a totally sedentary, overweight individual over the age of 50 should not suddenly embark on any intense aerobic activity like running and at the same time start severe dieting. The heart cannot cope with this sudden stress and starvation, increasing the likelihood of a heart attack. This does not mean they cannot do intense exercise; it means they should work up to it gradually under medical supervision.
Few people understand the importance of regular physical activity. They think their daily routine of shopping, housework and workplace activity is sufficient. As a result, 6 per cent of adults in India and 25 per cent of urban adults are clinically obese. The body mass index (BMI) or weight divided by height in metre squared is 30 or more, well above the acceptable norm of 23.
Statistics explain the reason for India being the diabetic capital of the world. Many are not yet diabetic but have “Metabolic Syndrome X”, which places them at high risk for heart attacks. Metabolic Syndrome X is diagnosed if you have:
• Raised blood pressure (systolic BP > 130 or diastolic BP > 85 mm Hg)
• Raised triglycerides ( > 150 mg/dL or 1.7 mmol/L)
• Reduced HDL cholesterol ( < 40 mg/dL or 1.03 mmol/L in men; < 50 mg/dL or 1.29 mmol/L in women)
• Raised fasting plasma glucose (FPG > 100 mg/dL or 5.6 mmol/L)
All these parameters can return to normal with a dedicated approach to diet and exercise.
After an emotionally exhausting and stressful day at work, 30 minutes of brisk walking or a workout in the gym can reduce stress, elevate the mood and rejuvenate the body. This is because exercise releases chemicals from the calf muscles that increase the levels of mood elevating serotonin in the brain. Regular exercise combats depression and increases feelings of self worth.
With exercise the lipid profile becomes normal and this prevents any build-up of harmful plaques in the blood vessels. This, in turn, prevents strokes and heart attacks.
Many often complain they are “too tired to exercise”. But actually, regular physical activity boosts energy levels. A good night’s sleep is the key to a productive day. Exercise does promote good sleep, but it needs to be completed at least an hour before bedtime. Or else the racy pumped-up feeling may not let you fall asleep. Students who want to study late can benefit from a short burst of high intensity exercise like a run around the house. It is healthier and probably more effective than coffee or other caffeine laced beverages.
Some of the chemicals released during exercise like the HSP (heat shock protein) help cells develop immunity and fight cancer and other diseases.
Exercise must be started young. The epidemic of childhood obesity is on the rise the world over. A child growing up in a family where no one exercises is unlikely to be motivated to do anything with spare time other than watch TV, play on the computer or eat snacks. Such children grow into obese adults with Syndrome X.
Walking for an hour and covering a distance of 4km in that time seven days a week is ideal. If you are between 20 and 50 years and have no health problems, jogging the same distance would be more beneficial. Children less than 10 years need to run for 20 minutes to half an hour every day. At least 20 minutes should be also spent on warming up, cooling down and stretching, preferably 10 minutes before and 10 minutes after exercise. Core strength is also essential for fitness and can be improved with sit-ups, push-ups and squats. Ten to 20 repetitions of each are all that are required.
Remember, exercise moderation is the key to success. Build up to your dream fitness level gradually to avoid strain to the heart, muscles, bones and joints.
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
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
Recently, there was some media hype about the so-called negative effects of exercise and suggestions that it could actually be detrimental to health. Many couch potatoes jumped on the bandwagon, proclaiming they had been right all along — that their kind of sedentary lifestyle was preferable and healthier than an active one.
But what the article in question actually said was that a totally sedentary, overweight individual over the age of 50 should not suddenly embark on any intense aerobic activity like running and at the same time start severe dieting. The heart cannot cope with this sudden stress and starvation, increasing the likelihood of a heart attack. This does not mean they cannot do intense exercise; it means they should work up to it gradually under medical supervision.
Few people understand the importance of regular physical activity. They think their daily routine of shopping, housework and workplace activity is sufficient. As a result, 6 per cent of adults in India and 25 per cent of urban adults are clinically obese. The body mass index (BMI) or weight divided by height in metre squared is 30 or more, well above the acceptable norm of 23.
Statistics explain the reason for India being the diabetic capital of the world. Many are not yet diabetic but have “Metabolic Syndrome X”, which places them at high risk for heart attacks. Metabolic Syndrome X is diagnosed if you have:
• Raised blood pressure (systolic BP > 130 or diastolic BP > 85 mm Hg)
• Raised triglycerides ( > 150 mg/dL or 1.7 mmol/L)
• Reduced HDL cholesterol ( < 40 mg/dL or 1.03 mmol/L in men; < 50 mg/dL or 1.29 mmol/L in women)
• Raised fasting plasma glucose (FPG > 100 mg/dL or 5.6 mmol/L)
All these parameters can return to normal with a dedicated approach to diet and exercise.
After an emotionally exhausting and stressful day at work, 30 minutes of brisk walking or a workout in the gym can reduce stress, elevate the mood and rejuvenate the body. This is because exercise releases chemicals from the calf muscles that increase the levels of mood elevating serotonin in the brain. Regular exercise combats depression and increases feelings of self worth.
With exercise the lipid profile becomes normal and this prevents any build-up of harmful plaques in the blood vessels. This, in turn, prevents strokes and heart attacks.
Many often complain they are “too tired to exercise”. But actually, regular physical activity boosts energy levels. A good night’s sleep is the key to a productive day. Exercise does promote good sleep, but it needs to be completed at least an hour before bedtime. Or else the racy pumped-up feeling may not let you fall asleep. Students who want to study late can benefit from a short burst of high intensity exercise like a run around the house. It is healthier and probably more effective than coffee or other caffeine laced beverages.
Some of the chemicals released during exercise like the HSP (heat shock protein) help cells develop immunity and fight cancer and other diseases.
Exercise must be started young. The epidemic of childhood obesity is on the rise the world over. A child growing up in a family where no one exercises is unlikely to be motivated to do anything with spare time other than watch TV, play on the computer or eat snacks. Such children grow into obese adults with Syndrome X.
Walking for an hour and covering a distance of 4km in that time seven days a week is ideal. If you are between 20 and 50 years and have no health problems, jogging the same distance would be more beneficial. Children less than 10 years need to run for 20 minutes to half an hour every day. At least 20 minutes should be also spent on warming up, cooling down and stretching, preferably 10 minutes before and 10 minutes after exercise. Core strength is also essential for fitness and can be improved with sit-ups, push-ups and squats. Ten to 20 repetitions of each are all that are required.
Remember, exercise moderation is the key to success. Build up to your dream fitness level gradually to avoid strain to the heart, muscles, bones and joints.
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
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