Medicinal effect of garlic in heart patients.

Medicinal effects of Garlic (Allium sativum) is known from the ancient days itself. It is used for treatment and prevention of many disease. Heart attack patients get several benefits with garlic intake. 

Active ingredient is Allicin which is an odorous sulfurous compound that has several medicinal effect. Following are the benefit of Garlic in heart attack patients. The main abnormality in blood vessels in heart attack patients is atherosclerosis. 

• It helps to reduce the blood clotting. It produce irreversible inhibition of platelet aggregation ,which is a blood component. Major action of drugs given in heart attack patients is to inhibit the platelet, which is responsible for blood clotting.
• Reduction of cholesterol and triglycerides levels which is responsible for formation of atherosclerosis and plaque in blood vessels leading to reduction in blood supply.Several studies showed 9 to 12% reduction in cholesterol and moderate reduction of triglycerides levels with its use.
• Help to reduce blood pressure which is also a risk factor for heart attack .There will be an average reduction of 11mm of Hg in systolic and 6.5 mm of Hg diastolic blood pressure.
• Garlic has anti atherosclerosis action,which help to reduce the formation of new atherosclerosis lesion and prevent the progression of older lesions.

Garlic is available as fresh cloves, powders, extract, tablets. At least one-half garlic clove per day  is required for medicinal effects.Although the tablets and powders are convenient, the amount of active ingredient is insufficient.

Some people may experience gut (gastrointestinal system ) symptoms such as flatulence(gas), chest pain and abdominal pain after garlic intake.

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How to avoid pregnancy after unprotected sex ?

Even though there are different effective contraceptive methods 50% of birth occurring in United States are due to unintended pregnancy. Teenage pregnancy is a major public health problem occurrence around 1 million unintended pregnancy each year ,this is very high compared to other developed nations. The term emergency contraception means the various methods used to prevent the pregnancy after unsafe sex.

After unprotected sex without regard to time of month there is about 8%chance of getting pregnant, this can be decreased to 2% by the use of pills.

Time - This tablets should be taken within 72 hour of unprotected sex.

Recommended tablets

1. Ovral.    2 tablets 12 hours apart
2. Lo/Ovral 4 tablets 12 hours apart
3. Preven(50mg ethinyl estrdiol and 0.25mg levonorgestrel)
4. levonorgestrel (0.75mg) 

The above drugs are available for women more than 17 yrs.

1. Levonorgestrel containing tablets are associated with fewer side effects and are more effective than estrogen and progesterone containing tablets.
2. Ulipristal acetate is also approved for avoiding pregnancy after unsafe sex.This tablet give protection up to 5 days.
3. Intrauterine contraceptive device IUCD if used within 5 days also give protection from pregnancy.

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Metabolic syndrome... Who is at risk?

Metabolic syndrome increases the risk of diabetes and insulin resistance. Prevalence of the metabolic syndrome is increasing worldwide. Incidence increases with age. Highest  incidence of metabolic syndrome is seen in native Americans. About 60 percentage of females and 45 percentage of men between 40 to 49 age group are affected. Rising prevalence of obesity also increases the metabolic syndrome.

Following are the risk factors of metabolic syndrome.

1. Overweight and obesity.

2. Sedentary lifestyle.

3. Aging.

4. Diabetes.

5. Coronary heart disease.

6. Lipodystrophy.

Overweight and obesity.

Obesity increases the waist circumference and the risk for metabolic syndrome. But people who are of normal weight can also develop insulin resistance and this syndrome.

Sedentary lifestyle.

It is a predictor of heart disease and related mortality. Sedentary lifestyle is associated with increased risk of central obesity, high triglycerides, low HDL (High dencity lipoprotein) cholesterol, high blood pressure and blood sugar. It has two fold increase incidence in those who watch television or computer more than 4 hours, compared to those who watch it less than 1 hour.

Age

As the age advances the risk of metabolic syndrome is increasing, this tendency is seen worldwide. It is seen in 44 percentage of males more than 50 yrs in USA. Incidence is more common in females.

Diabetes mellitus

There is increased incidence of diabetes and insulin resistance in people with metabolic syndrome. This inturn will increase the risk for heart disease.

Heart disease

People with metabolic syndrome have increased incidence of heart disease. This can be reduced by lifestyle and dietary changes and weight reduction.

Lipodystrophy

Both congenital and acquired is associated with metabolic syndrome.

Related Links

How will you identify that you have metabolic syndrome.

Obesity a rising problem 

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HbA1c and its correlation with blood sugar level - An info for diabetes patients

HbA1c is used for assessment of long term glucose control.This lab test reveals average blood glucose level over the past 2 to 3 months.

Major use of HbA1c

1.Assessment of optimal glycemic control in a given patient.

2.Blood glucose control status in between checkups.

This is a quality control testing. Along with regular blood glucose testing it is also used to assess the success of present treatment and help to make necessary change in the treatment.

HbA1c results are expressed as a percentage. Normal value is 4% to 6%. 1% change in HbA1c represent 30 mg/dl change in mean blood glucose value.

HbA1c and blood glucose value correlation

HbA1c value(%)	Mean blood glucose
14	380
13	350
12	315
11	280
10	250
9	215
8	180
7	150
6	115
5	80
4	50

       

<7%	Excellent control. Those who are on drugs and insulin should be aware of hypoglycemia
7%-8%	Good control. Here the aim is to get a level <7% which indicate there should be attempt for further improvement.
>8%	Poor control, indicate that diabetes is not well controlled.

Frequency of measurement of HbA1c

1.Those people who meet the treatment target it has to be measured once in 6 months

2.Those are not adequately  controlled once in 3months.

3.Special care is required in preconception care of women with diabetes initially monitor in once a month and once glucose level is controlled once in 6 to 8 weeks.This is important for maximum fertility and optimum fetal growth.

Need for strict control of diabetes

Those who have adequate control of HbA1c has lesser complication of diabetes such as

1. Eye problems

2. Kidney problems

3. Nerve related complications

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Exercise in knee joint osteoarthritis

Osteoarthritis pain occur during activity in weight bearing joints such as hip and knee. This will lead to physical inactivity. As osteoarthritis is very common this will lead to significant public health concern. Physical inactivity lead to increased risk for heart disease and for obesity.Exercise capacity is poor in  those with osteoarthritis of knee joint.

There is weakness of muscles over the knee joint in osteoarthritis. Since adequate muscle power is needed for joint protection muscle weakness results in further damage to the joint and decreases the exercise capability. Degree of weakness correlate with severity of joint disease and degree of limitation of mobility of joint.

Causes of muscle weakness

1.Decrease strength with age

2.As pain occur during activity ,there is tendency for physical inactivity this will lead to disuse atrophy

3.Alteration in gait as a protective mechanism decreases the load on affected joint and further decreases the muscle power.

Exercise program in osteoarthritis

For knee and hip joint osteoarthritis exercise improves the power and reduces the pain.

Effective exercise program are

1.Aerobic exercise 

2.Resistance training

Resistance training is aimed at strengthening of muscle power. Exercise is maximum effective if the affected people are trained for their daily activities. Certain exercise increases the pain in joints they should be avoided. Strengthening of muscle by repeated bending of knee against resistance. It is done by flexing and extending the knee joint. Low impact exercise such as water aerobics and water resistance training is also found to be useful. This is better tolerated than loading exercise such as running. For getting maximum benefit from exercise patient should be referred to an exercise class or to a therapist to plan individual home based exercise regimen.

Major challenge in exercise program is lack of compliance. Trial showed 30 to 50 percentage of people stopped exercise after 6 months and less than 50 percentage continued after one year. Previous history of successful exercise is the strongest predictor for continued exercise in a given patient.

Role of physician

1.At each visit he should reinforce the exercise prescription.

2.Help the patient to identify obstacles in continuing exercise.

3.Identify convenient time for exercise daily.

It is also observed that calorie restriction along with exercise is very effective in decreasing pain. It is shown that early exercise and muscle strengthening help to improve the cartilage function on joint by MRI study.

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How will you identify that you have metabolic syndrome.

Identification of metabolic syndrome is important because it will help to predict the risk of future heart disease and diabetic risk. Worldwide more and more people are affected by this. This is due to change in lifestyle and food habits. Metabolic syndrome is highest among native Americans. It has got 5 components. Increased waist circumference is more in females where as fasting triglycerides and hypertension is more common in males.

Five components of metabolic syndrome are the following.

1.Central obesity(waist circumference)

2.Increased triglycerides

3.Low HDL cholesterol.

4.Diabetes mellitus

5.Hypertension

Risk factors of metabolic syndrome

1. Overweight and obesity

2. Aging

3. Heart disease

4. Diabetes mellitus

5. Sedentary lifestyle 

6. Lipodystrophy

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