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Causes of Chest pain

How Air Pollution affects our health

I am Dr. Rajiva Gupta, senior consultant in Internal Medicine and Diabetology. I have my own clinic at Upjaar Wellness, at Ashok Vihar Phase II, New Delhi. Today, we will discuss pollution. We all know, we keep on reading it on the news, in the media that pollution is creating a havoc in many parts of the country, Delhi is the worst affected by this.

Now, what is pollution? Pollution is the introduction of contaminants in our environment, be it air, water or soil. As far as human beings are concerned, they are most affected by the contamination in the air because this is the problem which all of us are encountering so frequently and it is at its peak. So, air pollution consists of solid particles in gases and many pollutants are carcinogens. Apart from these dire consequences, air pollution is also having a great effect on the lungs, the bronchial and heart which affects the quality of life, the productivity of life in the individual as well as its health consequences. People who are most affected by pollution are the elderly as I said in the beginning, elderly and the children.

Elderly people those who are already having diseases like cardiac diseases and lung disease, their pre-existing conditions get aggravated. Patients develop shortness of breath; many times they land up into hospitals. Patients who are having bronchitis or asthma, their conditions get aggravated, their usage of medicine gets increased and the quality of life suffers. In certain cases, they become critically ill and get admitted in Intensive Care Units. Till now, it was understood that the pollution only affects the lungs but recently we have come to know that it also affects the heart and the mechanism is not clearly known but then patients who suffer pollution or are exposed to pollution they have problems related to their heart such as heart failure, heart attack, etc., and they land up in hospital. So, we see that pollution has got a far reaching influence both on the quality of life; the seriousness of illnesses, and sometimes it may even cause mortality, not directly but indirectly.

How can pollution be prevented? Pollution prevention is a pretty tough task because it involves changes in the policy level, at the administrative level. On an individual basis, one can use masks so the best masks are called the N95 masks which are expensive but they claim to reduce the inhalation of pollutants. The use of air purifiers, again they have got a, they have a lot of controversy about how they are effective or not but certainly the weight of evidence suggests that to some extent they do help in getting down the prevalence and incidence of pollution related respiratory problems. So, therefore, people are advised not to go out for walks in the early mornings because that puts them at a greater risk of exposure to pollution and try to exercise at home. Usages of masks, installation of purifiers at home and at work places are the steps which could minimize the level of pollution.

If you have any other further queries, you can consult me at lybrate.com.

 

Here are Reasons, Effects, Precautions of Hypertension.

I am Dr. Rajiva Gupta, senior consultant in internal medicine and diabetes. I have my practice at Upchar Valley in Ashok Vihar. Today we will talk about hypertension or high blood pressure.

Hypertension is a growing problem in the entire world and especially in the developing countries like India. Last surveys have found that hypertension is prevalent in almost 30% of adult population of India. Why is hypertension or high blood pressure increasing? The reasons are multi-factorial essentially because of bad lifestyle which includes obesity, diets like processed foods or restaurant food which is very high in salt, increase in mental stress and lack of physical activity. In addition to that, as the population ages, so does the prevalence of hypertension increases.

Why is hypertension so important to control? The reason is that researches found that hypertension is one of the most important modifiable factors for heart disease and strokes. Therefore, if a patient has got hypertension and if the blood pressure is controlled adequately, then the chances of developing a stroke or heart attack or heart failure or kidney failure or blindness get reduced markedly. However once the patient does not control the blood pressure and these complications occur, then it becomes a lifelong medical problem and adds to the quality of life- survival as well as the financial burden on the patient and his family. So blood pressure needs to be controlled meticulously.

Now, how to go about it? We, as physicians, always measure blood pressure of every patient who comes to our clinic irrespective of his symptoms and we are able to identify which are the patients who are likely to develop hypertension. If a patient comes to the clinic and his blood pressure is somewhere around 130 to 135, then we ask the patient to get a recheck done to see if the pressure is persistently elevated. At this point, I would like to mention that overall the agreed definition of hypertension is persistent blood pressure more than 140 upper blood pressure which is called the systolic blood pressure and more than 90 which is the diastolic blood pressure.

Secondly, if we find that the patient is having blood pressure more than this level then we give him counseling about lifestyle modification like control of diet, exercise, to get his other parameters checked like cholesterol levels, blood sugar levels and we discuss with the patient about the importance of blood pressure and treatment for blood pressure medication. Once we control blood pressure, we find that the patient’s quality of life improves and the prevalence of complications is also reduced markedly. Blood pressure control has been found to be one of the most cost effective modalities of treatment. Cost effectiveness means the cost of treatment of blood pressure is than when the complications occur.

As I had mentioned earlier, that once the complications because of hypertension occur then it leads markedly to financial burden on the patient’s family. Therefore, blood pressure is important to recognize. Ideally what is to be done is to prevent the occurrence of blood pressure by adopting a healthy lifestyle. If blood pressure has already occurred, then we should consult the doctor to treat it adequately in addition to modification of lifestyle which has already been addressed to. In this way, it will go a long way in reducing the burden of hypertension on the entire society.

In case, any of our viewers or listeners are interested in seeking any query on hypertension or seeking treatment of blood pressure, you can log on to the lybrate.com homepage and look for Dr. Rajiva Gupta.

Hello. I’m Dr Rajiva Gupta. I’m a senior consultant in internal medicine at Ashok Vihar and Fortis Hospital, Shalimar Park. My special areas of interest are diabetes and care of the elderly.

Now talking about care for the elderly, the branch of medicine that deals with the care of the elders is called Geriatrics anthology. The elderly patients present peculiar problems. They present not just discreet conditions, but with discreet syndromes. A syndrome is a constellation of symptoms and signs. In common, they are called the geriatric syndromes. The common geriatric syndromes are false, impaired cognition, deficiencies in a hearing, difficulty in vision, delirium. These syndromes are important because we have to investigate several different causes. For example, if the patient falls, it is not necessary that he may be having weakness in his legs. It is highly possible that the patient will be suffering from an acute infection or from some electrolyte imbalance or from CVA or cardiovascular problem. The patient is having disorientation, he is not oriented, he may have necessarily, he may be having, that he is having infection of the brain, he could as well be having electrolyte imbalance or any infection or a cardio-vascular problem. It means that the syndromes present, similar syndromes present with different types of illness in the elderly. The reason is that the physiological reserves of the elderly are just on the borderline and any acute insult that results in these syndromes. The approach to geriatric patients is slightly different from the way we approach people of other age.

So there are two components, one is the Curative component and another is comfort, or the palliative. That depends much on the functional ability of the patient. So if you have got an elderly person, above 80 years, he does regular exercise, enjoys his life, goes out for walks, the treatment of any condition in such a patient would be on the lines the management is done for a younger or a middle aged patient. Whereas, on the other end, if the patient is 70 years or 75 years, and he suffers from a problem, he is immobile, confined to bed, he is not able to take care of his own daily needs. For such patient, the aim would be to have a comfort care. So, the treatment of the elderly has to be individualized and surprisingly, there are not many guidelines which are available for treatment of elderly in different, for different medical conditions. SO the treatment for each individual has to be individualized, considering his individual circumstances. For example, if we take a very common problem like sugar, and we call that, there is a parameter called the Glycosylated hemoglobin, so we say that glycosylated hemoglobin for a normal should be less than 7% or less than 6.5 %. Bit for the elderly, because they may be having other illnesses, they may be having kidney disease or may be living alone in the house, they may not be able to take care, so in such patients, we will not go in for a very strict control, we’ll go in for a modest control, where the range may be say, around 8 or 8.5.

As physicians, we need to be aware that the number of elderly people is increasing, we need to be aware about their special needs, we have to give time once they come to our clinic and we have to define their problems and treat them accordingly.

I will be most willing and happy to answer to any questions, which can be approached through the lybrate website or they can seek consultation by telephone or physical consultation.