Category: General

Puberty is a time when the boy or girl becomes sexually mature. Puberty is an exciting phase for kids. Although the physical aspect of puberty triggers curiosity, the psychological aspects are also equally exciting. It is the stage when the appropriate hormones start acting slowly and steadily. As a result, boys gradually become men, and girls are on their way to becoming women.
It starts at between the ages 10 and 14 for girls and ages 11 and 16 for boys. Since the range for starting puberty is quite broad, it is not unusual to have a kid start and progress in puberty, but another kid of the same age not having any signs of puberty. However, these age ranges are not strict, and normal puberty in a small number of kids can start below this age.
There is a small gland in the head called the pituitary responsible for producing gonadotropins that start puberty. This gland is regulated by an area of the brain called the hypothalamus responsible for deciding the timing of puberty. The gonadotropins act on the testes (in boys) and ovaries (in girls) and produce hormones -testosterone (in boys) and estrogen (in girls). These hormones lead to most of the changes that we see externally in boys and girls in puberty.

Author
Dr. Mathew John

High blood glucose from diabetes can damage your blood vessels and the nerves that control your heart and its blood vessels. Over time, this damage can lead to heart disease. People with diabetes tend to develop heart disease at a younger age than people without diabetes. Adults with diabetes are nearly twice as likely to have heart disease or stroke as adults without diabetes. If you have any of these warning signs of a heart attack, you need urgent medical care.

• Pain or pressure in your chest that lasts longer than a few minutes or goes away and comes back
• Pain or discomfort in one or both of your arms or shoulders, or your back, neck, or jaw
• Shortness of breath
• Sweating or light-headedness
• Indigestion or nausea (feeling sick to your stomach)
• Feeling very tired

Warning signs can be different in different people. You may not have all the listed symptoms. Women may experience chest pain, nausea, and vomiting, feel very tired (sometimes for days); and have pain that spreads to the back, neck, throat, arms, shoulders, or jaw. People with diabetes-related nerve damage may not notice any chest pain, and so it is termed as “silent heart attack”. Only minor heartburn or extreme fatigue may be the only symptoms, Other than heart attacks, tic people are more susceptible to developing heart failure.

• Symptoms of heart failure include swelling of legs, difficulty in breathing, more at night, unable to perform routine activities without breathlessness, chest discomfort on exertion.

People with diabetes have a two to fourfold increased risk of CVD and are up to three times more likely to die after myocardial infarction than people without diabetes. Regular exercise training, individual dietary modification, and smoking cessation are significant lifestyle changes for the primary prevention of CVD. Certain glucose-lowering medicines like sodium-glucose cotransporter 2 (SGLT2) inhibitors (Empagliflozin, Dapagliflozin, Canagliflozin) or injectable GLP-1 receptor agonists (Liraglutide, Dulaglutide) can reduce the risk of heart disease and death in people with diabetes and cardiac risk. In addition, strict blood pressure control with BP lowering medicines and management of LDL with statins reduces the risk of heart attacks in people with diabetes.

When a heart attack occurs, the aim should be to reach the hospital at the earliest to undergo primary angioplasty of thrombolysis. Coronary angiography can help decide the need for coronary artery bypass grafting. Long term treatment of these individuals will include medicines like antiplatelet drugs(Aspirin, Clopidogrel, Prasugrel), Beta-blockers, Statins and ACEI inhibitors.

Author
Dr. Deepa

You can reduce your risk of developing heart disease by making the following changes:

• You can reduce the chances of developing heart disease by controlling blood sugar levels, blood pressure and cholesterol. Please make sure you get advice and support from your doctor to keep them within your target range. Monitor your blood glucose, glycated haemoglobin (HbA1c), blood pressure and blood cholesterol as advised by your doctor. Scientific studies have shown that normalising blood glucose, controlling hypertension to target with blood pressure lowering medicines, and using statins to keep LDL cholesterol levels on target helps reduce the risks of heart disease.
• Quit Smoking. Smoking makes it harder for blood to flow around your body, especially to your heart.
• Eat a healthy, balanced diet to protect your heart, significantly reducing saturated fat in your diet.
• Be physically active and do regular exercise. Avoid sitting for long periods.
• If you are obese or overweight, discuss with your doctor methods to help you lose some weight. Even losing a small amount can make a real difference.
• Take your medication as prescribed. Adherence to drugs controlling diabetes, blood pressure and cholesterol will help in reducing your risk of developing a heart attack.

Author
Dr. Tittu Oommen

Healthy eating habits and good blood glucose control helps to prevent the occurrence of heart disease. There is no one-size-fits-all approach to diet, but it is important to have a regular meal pattern with healthy carbohydrates like whole grains, vegetables and fruits. Avoid processed, baked, and deep-fried foods, shortenings, margarine as all of these contain transfat. Limit the use of high-fat dairy products and red meat, which contain large quantities of saturated fat. Aim for less than 2300 mg sodium/day ( 1 teaspoon salt/day). Try to include vegetables, fruits, legumes rich in fiber, fish such as salmon, mackerel, tuna, and sardines rich in omega-3 fatty acids in the diet.
In short, consuming complex carbohydrates (fibre rich foods), lean protein, heart-healthy fats and improving activity levels will form healthy lifestyle modification.

People with diabetes are at increased risk of heart disease. This can be because of various reasons: uncontrolled blood glucose levels, high blood pressure, high cholesterol levels, overweight, lack of physical exercise and smoking. In addition, some ethnic groups like Asian Indians are at higher risk compared to other populations. High blood pressure and high blood glucose make the blood vessel walls thick and less elastic.
The risk factors lead to increased injury and inflammation of the vessel wall, deposition of cholesterol and formation of plaques, and calcification. As these blood vessels become narrow, blood flow tends to slow down and form clots. These clots may get dislodged and block other blood vessels. Depending on the blocked blood vessels, it may be heart attack, stroke, blindness, or a block in the blood vessels of the lower limb leading to amputation. Managing these risk factors and controlling them to target has been found to reduce the risk of heart disease.

Author
Dr. Mathew John

Cardiovascular disease(CVD) is prevalent among people with diabetes. Many people with type 2 diabetes will eventually develop cardiovascular disease. People with diabetes are 2 to 4 times more likely than others to develop cardiovascular disease. Because this risk is so high, cardiovascular disease remains the most common cause of death; over 40-50 % of all diabetes deaths are due to cardiac diseases or stroke. It is more striking that younger people with diabetes have an increased risk of death due to CVD.

It appears that Indians are more susceptible to diabetes and cardiovascular disease. In Indians, cardiovascular disease occurs prematurely, i.e., one to two decades earlier than in the West. Compared with people without diabetes, Indians with diabetes have twice the mortality due to cardiovascular disease.

Author,
Dr Deepa G

Yes, Osteoporosis is treatable. However, the treatment of osteoporosis is not treating the bone alone. It includes adequate intake of nutrients (Calcium and Vitamin D), regular exercise, preventing falls and avoiding risk factors like smoking and alcohol. After discussing with your endocrinologist regarding the need for treatment, recommendations are given which are based on the chance of your risk of breaking a bone in the next 10 years using information such as the bone density test. There are several classes of medications used to treat osteoporosis. There are factors to consider when choosing the right osteoporosis medicine. These include sex, age, previous fracture, and other illnesses. In addition, the preference of the patient is considered like oral vs injectable treatment, daily vs once a week vs once a month/year treatment.

The main classes of medications that are currently available in India are:
·Hormone and hormone-related therapy: When osteoporosis is considered to occur due to low levels of oestrogen (in females) and testosterone (in males), treatment with these hormones is considered beneficial. Other related agents like Raloxifene and Calcitonin are also sometimes used.
·Bisphosphonates: These medications stop the body from re-absorbing bone tissue. There are several formulations (oral and injectable) with various dosing schemes (monthly, daily, weekly, and even yearly). These include Alendronate, Ibandronate and Zoledronic acid.
·Denosumab: It is available as an injection given every six months to women and men.
·Bone Building medications: These products build bone in people who have osteoporosis. The available medication is called Teriparatide and Abaloparatide. These drugs act like the bone hormone parathyroid hormone, and it stimulates new bone growth. It’s given by daily injection under the skin.
Once you have been diagnosed with osteoporosis, consult your endocrinologist to discuss the best treatment for you. It’s often not possible to say there is one best medication to treat osteoporosis. The ‘best’ treatment is the one that is best for the individual patient considering all factors.

Author- Dr. Tittu Oommen

Osteoporosis is a silent disease and usually does not produce any symptoms. Usually, the first sign of osteoporosis is a fracture; however, sometimes people notice that they have kyphosis (a hunchback) or a loss of height. Severe osteoporosis can be seen in X rays.
In screening camps, a peripheral DXA is commonly used. It measures the bone density at the heel. This could be considered as a screening test and should alert the physician that a more elaborate central DXA is needed. A central DXA uses a small dose of X rays to look at the bone of the spine, hip, and forearm to understand the density of bone. The density of the person’s bone is compared to that of a healthy person’s bone to get a T score. The level of the T score decides the degree of osteoporosis. There are other methods like QCT used for measuring bone density in research settings.

Author- Dr. Mathew John

To maintain healthy bones, women who are postmenopausal needs around 1200 mg of calcium along with adequate vitamin D, a healthy diet with adequate protein and regular weight-bearing exercise. This calcium intake can come from food, supplements or a combination of both. You can get the help of a dietician to understand if you take enough calcium.
You can even calculate it yourself using the calcium calculator (https://www.osteoporosis.foundation/educational-hub/topic/calcium-calculator).
The rest of the calcium can be supplemented with calcium tablets. Around 500 mg of calcium can be used daily in most patients with the intake is low. Some studies have shown a reduction in osteoporotic fractures with calcium.

Author- Dr. Deepa