Life Style Disease?Actually What It Is ? How can we Prevent it ?

Obesity, Diabetes, Hypertension, Hyperlipidemia, Dyslipidemia, Cancer , Hert Attack, Brain Attack

1. Common Life style Disorders

2. Common Life style disorders Obesity Diabetes Hyper cholestremia Hyper Tension Heart / Brain Attack Hepatic/ Renal failure Cancer

3. BMI < 18.5 = under wt. 18.5 – 25 = target 25 – 30 = over wt. 30- 40 = obesity > 40 = extreme / morbid

4. Waist male > 102 Cm Female > 88Cm or Women -35” Men -40” High Risk Waist Line & Obesity

5. Required calories/ day based on type of work Obese – clerical x 80 Kg = 80x 20 = 1600 cal. Obese - moderate x 80Kg= 80x30 = 2400 cal. Obese – hard x80 kg = 80 x 35 = 2800 cal.

6. 2 -HYPER CHOLESTREMIA DysLipidemia

7. Risk-Consequences Insulin resistance  Hyper lipidemia Hypertension Artery – atherosclerosi s Coronary Cerebral Retinal  Renal Deep veins CAD – 34% in males , – 16 % in females DM - 62 % in males 47 % in females -Type-II

8. Criteria for investigation 16-80 yrs of Men Hypertensive cases Obese children & Females F/ H/o Hyper cholestremia H/o Oral Contraceptive medication H/O CAD?CVA etc....

9. Risk personalities Diabetic Existed CAD / CVD Deep vein disorders ??

10. Complications Atherosclerosis – > ischemia --> CAD – >arrhythmia – >heart failure Aortic / Cerebral aneurism Peripheral Vascular Disease Gangrene R enal A rtery S tenosis Retinal Artery Stenosis Systolic Hypertension Cholesterol Embolism Fatty liver - > Cirrhosis -> CA

11. Normal Desirable Borderline Risk Cholesterol ↓ 200 ↓ 200 200-↓ 239 ↑240 HDL 40 -70 > 60 < 35 LDL 90 -200 < 70- 100 130-159(BH) >160-190 TGL 60 -160 150-199 (BH) >400 VLDL 10- 130 Chylomicron Up to 28

12. TOTAL CHOLESTEROL/HDL Up to 5 Low Risk 3.3—4.4 Average Risk 4.7—7.1 Moderate Risk 7—11 High Risk > 11

13. LDL / HDL SAFE SIDE 1 Border Line 3.5 High Risk 6

14. Extras Lpa ↓ 30 mg/ dL Apo lipoprotein ↓120mg% Increased risk Apo lipoprotein ↑160mg% protective Apo lipoprotein-B 100-120mg% Apo lipoprotein-B ↑120mg%HighRisk

15. additional HS CRP – above 3 gm /L ( risk) Normal < 1 mg/ L .. ApoB – 55 – 140 mg /dl (Male) 55 – 125 mg / dl (Female) - in DM – 80mg/ 100 ml. Non HDL = TC – HDL >100 - risk >130 = high risk.

16. 3 -DIABETIS

17. A/c & C/c Complications:- A/c- Complications :- Hypo-Glycemia D iabetic K eto A cidosis C/c Complications:- Micro & Macro -Vascular Micro Eyes-Kidneys-Heart & CNS MacroBlood vessels Athero - -Sclerosis.

18. Hypoglycemia Is results from an imbalance between- MEDICATION & Food Intake/Exercise CLINICAL MANIFESTATIONS:- Neurogenic Neuroglycopenic Diaphoresis Cognitive Impairment Palpitations Fatigue Tremor Dizziness/Faintness Arousal/Anxiety Parasthesia/ Hunger Pallor, HPTN Inappropriate behavior Focal Neurologic Deficit Seizures/Loss of Consciousness Death

19. D iabetic K eto A cidosis Due to Relative/Absolute deficiency of circulating Insulin (Uncontrolled Catabolism) TRIAD of DKA is Metabolic Acidosis- Ph < 7.3 HyperGlycemia > 250 -300 mg% Presence of Ketone in- Blood/Urine

20. S/S of DKA Rapid(Kussmauls) Breathing An Acetone odor of breath Nausea/Vomiting Diffuse abd. Pain (30%) O/E:- ALTERED S.Electrolytes ? BS- >300mg% Anion gap >13mEq/L S.phos. .>7.3, S.Hco3->18

21. An-ion gap In fact ,it is defined as the difference between the total concentration of measured cations ( Na & K) and that of the measured anions ( Cl & HCO3) So Anion gap represents the un measured anions in plasma. Na + K = Cl + HCO3 136 + 4 = 100 + 25 140 - 125 = 15 CATION ANION

22. Acid Base disorders are often associated with alteration in the anion gap. Normal Na = 135  145 mEq /L K = 3.5  5 Cl = 95  105 HCO3 = 24  30

23. S.Na HYPO NATREMIA Delirium –Confusion Brain shrinkage- SAH Thrombosis Convulsions- Tremor Brisk- reflex Coma Death HYPER NATREMIA Cerebral oedima Agitation & Apathy Disorientation &Confusion Dizziness & Head ace Depressed Reflex & Ataxia Cheyne Stroke Breathing Hypothermia

24. S. K HYPO KALEMIA Proximal Muscle Weakness Paraesthesia - depressed tendon reflex Arrhythmias - Heart block – sudden death GIT – Hypo motility Nocturia, Poly urea , Poly dypsia HYPER KALEMIA Brady Cardia Hypo tension Heart block Cardiac arrest Paraesthesia

25. Diagnosis RBS >200 HbAIC Urine glucose Urine ketones Lipid Profiles TFT C. Peptide …..

26. Risk factors CAD (4-fold – (silent MI) Renal (17 fold )- 30 % Retinal ( 25 % increased) Neural Hypertension Foot problems – 15 % Sexual – 30 %

27. Early Diagnosis

28. investigations Criteria for testing people:- AGE :- >45 BMI :- >25 FH/o DM H/o CAD/CVA H/o GD H/o HPTN/Dys Lipidemia H/o PCOD Habitual Physical Inactivity.

29. Normal BS FBS-------70—110mg% PPBS ---- 90---130mg% RBS------ 80----120mg% F/Ins----- 6-----27UIu/mL C.Peptide-0.18- 0.63 pmol/ml (0.2mmol/L )

30. DIABETIC PROFILE American Diabetic Association S/S of DM+ FBS ------- > 126mg/dl > 120 RBS ------- > 200mg/dl >160 PPBS ------ > 200mg/dl >140 FBS MORE THAN 140 (120mg/dl) on at least 2 occasion

31. STAGES OF PROTEINURIA Normal < 30mg/24 hr Micro albuminuria 30 – 150 mg / 24hr Mild 150 – 500 mg / 24hr Moderate 500 – 1000 mg / 24hr Heavy 1000 – 3000 mg / 24hr Nephrotic > 3500 mg / 24hr

32. HbA1C ..

33. CORRELATION OF HbA1c WITH Glucose Levels HbA1C Glucose Level 330 300 270 240 210 180 150 120 ----Excellent----- 13 12 11 10 9 8 7 6 (Normal)

34. HbA1C .. HbA1c -- < 9% Good Control 9-10% Fair Control > 10%  Poor Control < 6.5 Non Diabetic 6.5-8 Moderate Level > 8 %  Action Suggested

35. S.INSULIN Fasting -↓5 Uiu/ml 2-3 very good 5-15 High over15 - very high risk

36. Aim /Goal of Trt. HbAIc = < 7.4% LDL = < 100 mg% Bp = < 130/ 80 mg%

37. management

38. Contd…. Postural Hypotension-Use of supportive stockings to prevent venous pooling in the Legs Gastro Paresis- Low Fibre/Fatty food, Decrease ‘meal size’ ,Increase Exercise. Diabetic Nephropathytrt.HPTN(BP130/80) Low Protein, Control Lipidemia-LDL -<100 Early detection of diseases

39. Contd… BY IMPROVING GLYCEMIC/LIPID CONTROL Hospital Mortality can reduce -34% Sepsis “ “ -46% Haemodialysis “ “ -41% Transfusion “ “ -50% Polyneuropathy “ “ -44%

40. 4- H YPER - T ENSION A Silent Killer..

41. O/E 30 – 39 years -> 20% have HPTN 40 – 49 years -> 30 % 50 – 60 years -> 60 %

42. Grades of Bp Optimal value- <120/80 mm of Hg Normal Value- < 130/85 “ High Normal- 130-139/ 85-89 HYPER TENSION - 140/90 Isolated systolic HPTN  SBP- >140 , DBP < 90 MALIGNANT HPTN  BP=200/130-140 Papilledema & Renal Dysfunction.

43. classification Pre-Hypertension Systolic 120-139mmHg Diastolic 80-90mmHg Stage -I 140 - 159 90 -99 Stage -ii >160 > 100

44. Metabolic X syndrome In 1988 Dr.Jerald Revan Common P/C as Heart attack(50%) &Stroke (80%) O/E Obesity – M >90--102cm( 40’’) F >80-- 88cm (35’’) TGL - >150 mg / dL HDL - < 40 in males, <50 in females. BP – Systolic > 130 mm of Hg. - Diastolic > 85 mm of Hg. FBS - >110 mg/ dL ANY OF THREE CONSTITUTE METABOLIC X SYNDROME

45. 6- cancer Varieties -- More than 250 types Main cause is due to imbalance of P.O Gens P 53 suppressor genes

46. Tumor Markers in Clinical use These are nothing but the products produced by the Tumors or by the body in response to the Tumor. They may be Enzymes, Hormones or Proteins in nature & are relevant for Screening, Diagnosis, Determine prognosis , Monitoring the course of disease & effectiveness of Trt. ,& detecting relapse. Usually Tumor Marker test is done by using Immuno- Assays such as ELISA, RIA , & CLIA

47. Commonly used Tumor Markers T M N V Abnormal Levels CEA <2.5 ng/ml(ns) < 5 ng/ml (s) CA-colon ,Pancreas , GIT , Ovary, Lung , Thyroid , Breast Cirrhosis, IBD, COPD, Cholecystitis , Pancreatitis. CA125 0- 35 U/ml CA-Ovary , Endometriosis, Ovarian cyst, Fibroids, IBD Cirrhosis , Peritonitis , Pancreatitis. CA15.3 7.5- 53.0U/ml Breast, Lung, Pancreas, Ovary, Liver, Colo - Rectal CA

48. CA19.9 CA 27.29 < 33U/ml < 25U/ml CA-Pancreas , Colon , Hepato - billiary , Ovary Colon , Breast ,Stomach , Kidney , Lung , Ovary, Pancreas , Uterus , Liver , Endometriosis, Ovarian cyst, Benign breast Kidney & Liver diseases. AFP < 2ong/ml CA-Liver , Ovary , Testis ,Cirrhosis ,Hepatitis PSA < 4 ng /ml CA Prostate , Hypertrophy βHCG < 10mIU/ml Germ cell Neoplasm , Trophoblastic disease Chorio carcinoma , Testicular- Tumor , CA GIT, Duodinal Ulcers , Cirrhosis , IBD Benign Breast ,CA Lung &Pancreas , Pregnancy.

49. Commonly used Tumor Markers TM N V Abnormal Levels TG 0 – 55 ng /ml CA-Thyroid, Thyroiditis LDH 100-210u/l CA- Testis,Ewing’s Sarcoma,Non Hodgekin’s Lymphoma, Seminoma,A /c Leukemia Metastatic Carcinoma NSE < 13ng/ml Tumors of CNS Neuroblastoma,APUD Tumors Small cell LungCancer .

50. Commonly used Tumor Markers ADH 1-5 pg/ml Small cell Lung cancer, Adeno carcinoma , Porphyria CT Basal < 0.155ng/ml(m) <0.105 (w) Thyroid modularly carcinoma Pernicious Anemia, Thyroiditis CK-BB 40-200u/l(m) 35- 150u/l(w) Breast, Ovary , Colon, Untreated prostatic cancer Renal failure , Bowel Infarction, Stroke.

51. O/Investigations:- Immuno Bio-chemistry Flow Cytometry Radiological Hysto -pathological

52. FM- Disorders TSH > 5.5= 13% BS= 39% Osteopoenia= 40% Osteoporosis = 12% Anemia:- 34 %- Ideal Hb =12% 44%- Mild anemia(10-12gm%) 18% - Moderate anemia 4% Severe anemia

53. HOMOEOPATHIC MANAGEMENT HOMOEOPATHIC MANAGEMENT

54. n DR.P.N. Karam Chand,MD (Hom.) HOD of Medicine D P M H M C, Chottanikkara Kochi- Kearala Mob: [phone] With love &Regards…… DR.P.N. Karam Chand, MD (Hom.) HOD of Medicine D P M H M C, Chottanikkara Kochi- Kearala Mob: [phone]