0

1

2

LIFE STYLE

• ROUTINE

• DRESS

• EAT

• EXERCISE/PHYSICAL ACTIVITY

• DRINK

• SMOKE

• TECHNOLOGY

• BELIEF

• ATTITUDE

3

ROUTINE

-SLEEPINESS

-STRESS

-ANXIETY

-DEPRESSION

4

DRESS

-POOR EXPOSURE TO SUNLIGHT

-MORE EXPOSURE TO VECTORS, ALLERGENS.

5

EAT

-OBESITY

-VITAMIN D DEFICIENCY

-VITAMIN B12 DEFICIENCY

-GASTRIC REFLUX

6

7

OBESITY

• OBESITY-IS A CONDITION WHERE A PERSON HAS ACCUMULATED SO

MUCH BODY FAT THAT IT MIGHT HAVE A NEGATIVE EFFECT ON THEIR

HEALTH

• BODY FAT CONTENT -HIGH ADIPOSITY IN INFANCY

-LOWEST AT 5-6 YRS

-GRADUAL INCREASE TILL ADOLESCENCE.

• OBESITY > 2 YRS -BMI > 95TH PERCENTILE

• OVERWEIGHT -BMI 85TH- 95TH PERCENTILE

• BMI -WT IN KG/ HEIGHT IN M2

8

CUT OF VALUES OF BMI FOR OVERWEIGHT

Agency Tendency for

overweight

State of overweight

WHO >25 kg/m2 >30 kg/m2

IOTF >23kg/m2 >25 kg/m2

INCHS >85th centile >95thcentile

9

OBESITY• AMONG DELHI SCHOOL CHILDREN, 5% OBESITY

AND 17-19% OVERWEIGHT . SIMILAR FIGURES IN

REST OF INDIA ALSO

• PREVALENCE OF OBESITY AND OVERWEIGHT IS

HIGHER IN BOYS THAN IN GIRL

10

OBESITY CONTINUE………

ETIOLOGY

FACTORS RESPONSIBLE

- HEREDITARY

-ENVIRONMENTAL FACTORS

TYPES

-EXOGENOUS

-ENDOGENOUS

11

OBESITY CONTINUE..

• EXOGENOUS (95%)

-PHYSIOLOGICAL IN EARLY CHILDHOOD

- CONSTITUTIONAL OR FAMILIAL

-OVER EATING ( BEHAVIORAL)

- POOR PHYSICAL ACTIVITY

1) HABITUAL

2) PATHOLOGICAL: PHYSICAL HANDICAPS

12

OBESITY CONTINUES……..

• ENDOGENOUS(<5%)

ENDOCRINAL

-HYPOTHYROIDISM

-CUSHING SYNDROME

-PCOD

GENETICS

-LAURENCE –MOON-BIEDL SYDROME

-PRADER-WILLI SYNDROME

MONOGENETIC

-LEPTIN DEFICIENCY

13

OBESITY CONTINUES

HYPOTHALAMIC

-POST MENINGITIC/ENCEOPHALITIC SEQUELE

- FROHLICH SYNDROME

DRUGS

- STERIODS,VALPROATE,CLONAZAPAM

14

OBESITY CONTINUES….

COMPLICATIONS- MOST CASES OF CHILDHOOD OBESITY ARE MERELY

OVERWEIGHT WITH RARE COMPLICATION EXCEPT

PSYCHOLOGICAL CONCERN AND POOR BODY

IMAGE.

EXTREME OBESITY HAS SIGNIFICANT MORBIDITY

BEHAVIORAL : - SOCIAL /PSYCHOLOGICAL STRESS 15

OBESITY CONTINUES….

SKELETAL : -GENU VALGUM, SLIPPED

FEMORAL

EPIPHYSIS.

RESPIRATORY - OBSTRUCTIVE SLEEP APNEA

SYNDROME

CARDIOVASCULAR -HYPERTENSION

METABOLIC -HPERLIPIDEMIA,DM

OBESITY IN LATER LIFE 16

OBESITY CONTINUES

RARE COMPLICATION OF OBESITY

PICKWICKEN SYNDROME

PERSISTANT RESPIRATORY DISTRESS WITH

HYPOXIA,CYANOSIS,POLYCYTHEMIA,

CARDIOMEGALTY AND CCF.

17

OBESITY CONTINUES….

PREVENTION OF OBESITY

-START IN EARLY CHILDHOOD

-HARDER TO TREAT IN ADULTS

18

OBESITY CONTINUES….

MANAGEMENT

• DIETARY CHANGES

- LOW CALORIE, LOW FAT

- NORMAL PROTEIN

- HIGH FIBRE

- AVOID JUNK FOOD AND CARBONATED

- DRINKS

WEIGHT REDUCTION 500GM/WEEK

19

OBESITY CONTINUES….

• ENCOUARGEMENT OF PHYSICAL ACTIVITY

-OUTDOOR GAMES AND SWIMMING

• TREATMENT .OF IDENTIFIABLE CAUSE.

• PSYCHOSOCIAL SUPPORT TO CHILD AND FAMILY

20

OBESITY CONTINUES….

• DRUGS

ORISTAT-(GASTRIC LIPASE INHIBITOR)

SIBUTRAMINE(NEUROTRANSMITTER MODULATOR)

LEPTIN (LEPTIN DEFICIENCY)

OCTEOTRIDE ( HYPOTHALAMIC OBESITY)

• SURGERY-GASTRIC BANDAGE OR JEJUNOILEAL BYPASS(

BMI>40)

21

LIFE STYLE CHANGES AND OBESITY MANAGEMENT

• CHANGE IN SEDENTARY LIFE STYLE, DECREASE

CONSUMPTION OF CALORIE DENSE FOOD AND

INCREASE OUTDOOR ACTIVITY TEND TO

DECREASE THESE DISORDERS.

22

MESSAGE ABOUT EATING HABITS

• NUTRITIONAL DISEASES ARE CHANGING WITH CHANGING

LIFE STYLE

• TRADITIONAL BELIEF LARGE WEIGHT IS HEALTHY

….WRONG

• MANY ACUTE /CHRONIC/RECURRENT DISORDERS MAY

HAVE NUTRITIONAL BASIS

• KEEP AN EYE OPEN

23

COMPUTER VISION SYNDROME

• IT IS ALSO CALLED DIGITAL EYE STRAIN.

• IT IS A GROUP OF EYE AND VISION RELATED PROBLEMS

DUE TO PROLONGED USE OF COMPUTER , TABLET, CELL

PHONE USE.

• EYE DISCOMFORT AND VISION PROBLEMS- INCREASE

WITH AMOUNT OF DIGITAL SCREEN USE.

24

CVS CONTINUE……..• SYMPTOMS-

- EYESTRAIN

-HEADACHE

-BLURRED VISION

-DRY EYES

-NECK AND SHOULDER PAIN

• AGGRAVATING FACTORS

-POOR LIGHTING

-GLARE AT SCREEN

-IMPROPER VIEWING DISTANCE25

CVS CINTINUES…….

-POOR SITING POSTURE

- UNCORRECTED VISION PROBLEMS

26

CVS CONTINUES…….

• VISUAL SYMPTOMS DEPEND ON- LEVEL OF VISUAL ABILITY

-AMOUNT OF TIME SPENT ON

LOOKING DIGITAL SCREEN

• MANY OF VISUAL SYMPTOMS ARE TEMPORARY AND

DECLINE AFTER STOPPING COMPUTER WORK

• MANY PEOPLE MAY EXPERIENCE REDUCED VISUAL

ABILITY,BLURRED VISION EVEN AFTRE STOPPING WORK

ON COMPUTER

27

CVS CONTINUES…

• IF CAUSE OF PROBLEM NOT CORRECTED , WORSONS THE

FUTURE USE OF DIGITAL SCREEN

DIAGNOSIS-HISTORY

- VISION ACUITY MEASUREMENT

- REFRACTION

28

CVS CONTINUES……

MANAGEMENT

• EYE CARE - SPECIAL LENS DESIGN,LENS COATING.

- PROPER BODY POSITIONING

29

CVS CONTINUES…….-ANTI GLARE SCREEN-USE SCREEN GLARE FILTER

• SEATING POSITION

-CHAIR SHOULD BE COMFORATABELY

PADDED HEIGHT SHOULD BE

ADJUSTED SO THAT

FEET SHOULD REST FLAT ON FLOOR

- IF CHAIR‘S ARMS SHOULD BE ADJUSTED

THAT IT SHOULD PROVIDE ARM SUPPORT WHILE TYPING

WRIST SHOULD NOT REST ON KEYBOARD.

30

CVS CONTINUES…….

LOCATION OF COMPUTER SCREEN

-15-20 DEGREE BELOW EYE LEVEL

-20-28 INCHES AWAY FROM EYES

REFERENCE MATERIAL

-ABOVE THE KEYBOARD AND BELOW THE MONITOR

-IF NOT POSSIBLE-DOCIUMENT HOLDER BESIDE THE

MONITOR

31

CVS CONTINUESLIGHTENING

-AVOID GLARE FROM-OVERHEAD LIGHTING OR WINDOWS

USE DRAPES AT WINDOWS AND USE LOWER WATTAGE BULB IN DESK

LAMP

• REST BREAK-

-REST YOUR EYE FOR 15 MINUTE AFTER 2 HRS OF CONTINUOUS

COMPUTER USE.

• BLINKING

- BLINK FREQUENTLY TO MINIMIZE THE PROBLEM OF DRY EYE .

32

CVS CONTINUE……

33

VITAMIN D DEFICIENCY

• RICKETS- FAILURE OF MINERALISATION OF GROWING

BONES.

• RDA NEWBORN-400 IU/DAY

CHILDREN- 600IU/DAY

ADOLESCENTS 800IU

34

PHYSIOLOGY OF VITAMIN D

SKIN DIET

(7 DEHYDROCHOLESTEROL) D2&D3

UV LIGHT

VITAMIN D 3 (CHOLECALCIFEROL)

LIVER

25 (OH) D3

KIDNEY

1 HYDROXYLASE 24 HYDROXYLASE

1,25 (OH)2D3 24,25 (OH) D3

(ACTIVE) (INACTIVE FORM)

35

PATHOPHYSIOLOGY

VITAMIN D DEFICIENCY

REDUCED CA AND P ABSORPTION FROM GUT AND KIDNEYS

RISE IN PARATHORMONE

CALCIUM MOBILISATION FROM BONES AND RESORPTION FROM KIDNEYS

DEFICENT MINERALISATIION

INCREASED OSTEOBLASTIC ACTIVITY WITH ELEVATED LEVEL

OF ALKALINE PHOSPHATASES -!ST MARKER

INCREASED RENAL ABSORPTION PF CALCIUM

PHOSPHORUS EXCRETION AND LOW LEVEL OF P -2ND MARKER

36

ETIOLOGICAL CLASSIFICATION OF RICKETS

1) VIT D DEFICIENCY (NUTRITIONAL RICKETS)

-HIGHER REQUIREMENT

-INADEQUATE DIETARY INTAKE

-LACK OF SUN EXPOSURE

-POOR STORES AT BIRTH

-MALABSORPTION STATES

-ANTICONVULSANT THERAPY

37

CLASSIFICATION OF RICKETS

2)VITAMIN D RESISTANT (REFRACTORY RICKETS)

CHRONIC HEPATIC DISEASE

CHRONIC RENAL DISEASE

HYPOPHOSPHATEMIC RICKETS

RENAL TUBULAR ACIDOSIS OR FANCONI DISEASE

3)VITAMIN D DEPENDENT RICKETS

TYPE 1-AUTOSOMAL 1-HYDROXYLASE DEFICIENCY

TYPE 2-END ORGAN RESISTANCE TO VITAMIN D

38

RICKETS

39

CLINICAL MANIFESTATION

6 MONTHS – 2 YRS

CHANGES

CRANIOFACIAL

• CRANIOTABES-SOFTENING AND THINNING

IF SKULL BONES PING PONG LIKE APPEARANCE.

• FRONTAL BOSSING.

40

CLINICAL MANIFESTATION

• CAPUT QUARDRATUM—BOX HEAD OR HOT COSS BUN LIKE

DUE TO FRONTOPARIETAL BOSSING

• DELAYED DENTITION

• DELAYD CLOSURE OF ANTERIOR FONTANEL.

41

CLINICAL MANIFESTATIONTHORACIC CHANGES-

• RICKETIC ROSARY-WIDENING OF

COSTOCHONDROL JUNCTION

• STERNAL DEFORMITIES

PECTUS EXCAVATUM

PECTUS CARNIATUM42

CLINICAL MANIFESTATION

HARRISON SULCUS-GROOVE ALONG LOWER COSTAL MARGIN

LIMB DEFORMITIES

• WIDENING OF WRIST/ANKLES

43

CLINICAL MANIFESTATIONS

• ABNORMAILITIES IN LOWER LIMBS

-KNOCK KNEE

-BOW LEGS

44

CLINICAL MANIFESTATIONSSPINAL DEFORMITIES

• KYPHOSIS

• SHORT STATURE-SPINAL DEFORMITIES

GENERALIZED HYPOTONIA

• POT BELLY

• VISCREOPTOSIS

• OTHER MANIFESTATIONS

–RECURRENT RESPIRATORY INFECTIONS

45

DIAGNOSIS

SYMPTOMS

RADIOLOGICAL CHANGES

• WIDENING OF EPIPHYSIAL PLATES

• FRAYING

• CUPPING

• SPLAYING

46

DIAGNOSIS

BIOCHEMICAL CHANGES

• ELEVATED S.ALKALINE PHOSPHTASES LEVEL->20 KA

UNITS

• LOW S.PHOSPHORUS LEVEL

• SERUM VITAMIN D LEVELS- <5 NG/ML

47

TREATMENT OF RICKETS

• STROSS REGIMEN

-SINGLE DOSE OF ORAL OR IM 300000-600000 IU ALONG

WITH ORAL CALCIUM

• OR 60000 IU× 10 DAYS.

• OR 2000-6000 IU/DAY

• REPEAT X RAY AFTER 2-3 WEEKS

• ABSENCE OF LINE OF PREPRATORY CALCIFICATION-REPEAT SAME DOSE

• REPEAT X-RAY AFTR 4-6 WEEKS –NO IMPROVEMENT

INVESTIGATE FOR OTHER CAUSES.

48

PREVENTION

• ADEQUATE EXPOSURE TO SUNLIGHT

• VITAMIN D SUPPLEMENTATION (400IU/DAY) IN PRETERM

AND RAPIDLY GROWING CHILDREN

49

MEGALOBLASTIC ANAEMIA

• ANAEMIA WITH PRESENCE OF CHARACTERISTICS MEGALOBLASTS IN

PERIPHERAL SMEAR.

• COMMONLY DUE TO DEFICIENCY OF –VITAMIN B12 , FOLIC ACID

• VITAMIN B12 –PRESENT IN ANIMAL SOURCES

ABSENT IN PLANT SOURCES

SYNTHESIZED BY COLONIC BACTERIA

• RDA-0.5-1.5 MG/DAY

• ETIOLOGY-RARELY DIETARY

USUALLY DUE TO CONGENITAL/ACQUIRED DEFECT IN

ABSORPTION

50

COMMON MANIFESTATION OF B 12

• MACROCYTIC ANAEMIA

• GLOSSITIS

• NONSPECIFIC GASTROINTESTINAL

SYMPTOMS(ANOREXIA,NAUSEA,VOMITING.

• NEUROLOGIC SYMPTOMS

(DEMENTIA,DEPRESSION,PSYCHOSIS)

• SKIN HYPERPIGMENTAION -KNUCKLES AND

THIGHS.

51

DIAGNOSIS

• MEGALOBLASTIC ANAEMIA THAT DOES NOT RESPOND TO

FOLIC ACID THEREPY

• LOW SERUM VITAMIN B12 LEVELS(<100 PG/DL)

• METHYLMALONIC ACIDUREA

• SHILING TEST

52

MANAGEMENT

• ORAL THEREPY USELESS-DEFECTIVE ABSORPTION

• CASES WITHOUT NEUROLOGICAL SIGNS-LIFE LONG

MONTHLY THERAPY WITH IM VITAMIN (1MG)

• CASES WITH NEUROLOGICAL SIGNS-DAILY THERAPY X 2

WEEKS,FOLLOWED BY LIFE LONG MONTHLY THERAPY

53

SUBSTANCE ABUSE

• TOBACCO AND ALCOHOL USE STARTS DURING

ADOLESCENCE.

• ALCOHOL(21%), TOBACCO(14%), CANNABIS(3%), AND OPIUM

(0.4%) ARE THE MOST PREVALENT SUBSTANCE ABUSE IN

INDIAN ADOLESCENCE.

• ADDICTS ARE MORE PRONE TO ACCIDENTS, INJURIES,

VIOLENCE, TRADING SEX FOR DRUGS, HIV, HEPATITIS C,

SEXUALLY TRANSMITTED DISEASE AND TUBERCULOSIS.

54

DEPRESSION

• DEPRESSION IS THE TOP CAUSE OF ILLNESS AND

DISABILITY AMONG ADOLESCENTS AND SUICIDE IS

THE THIRD CAUSE OF DEATH.

• COMPLETED SUICIDES ARE HIGHER IN BOYS

• ATTEMPTED SUICIDES ARE HIGHER IN GIRLS

55

SOCIAL CHALLENGES• MEDIA

• WITH THE AVAILABILITY OF ELECTRONIC MEDIA, CHILDREN

ARE EXPOSED TO INFORMATION FROM ALL ACROSS THE

WORLD.

• THIS EXPOSURE IS UNSUPERVISED BECAUSE OF WORKING

PARENTS AND INCREASING USE OF ELECTRONIC GADGETS.

• DUE TO INABILITY TO SEPARATE FACT FROM FANTASY,

CHILDREN MAINLY ADOLESCENTS SUCCUMB TO THE

GLAMOROUS PORTRAYAL OF TOBACCO OR ALCOHOL

CONSUMPTION, UNREALISTIC EXPECTATIONS, PHYSICAL

AGGRESSION, DESTRUCTIVE BEHAVIOR AND UNPROTECTED

SEX.56

MENTAL HEALTH PROBLEMS CONT…)

SLEEP DISTURBANCE

• DURING THE PERIOD OF RAPID GROWTH,

ADOLESCENTS HAVE INCREASED SLEEP

REQUIREMENT.

• INADEQUATE SLEEP MAY CAUSE POOR SCHOOL

PERFORMANCE , DAYTIME DROWSINESS,

AGGRESSIVE BEHAVIOR, CONDUCT DISORDER,

ANXIETY, RESTLESS LEG SYNDROME AND

DEPRESSION.

SLEEP DEPRIVED TEENS MAY HAVE PERIODS OF

57

MENTAL HEALTH PROBLEMS CONT…)

• INADEQUATE SLEEP MAY CAUSE POOR SCHOOL

PERFORMANCE , DAYTIME DROWSINESS,

AGGRESSIVE BEHAVIOR, CONDUCT DISORDER,

ANXIETY, RESTLESS LEG SYNDROME AND

DEPRESSION.

• SLEEP DEPRIVED TEENS MAY HAVE PERIODS OF

SUBCONSCIOUS BOUTS OF SLEEP DURING THE

DAYTIME, MAKING THEM PRONE TO INJURIES AND

ACCIDENTS.58

LIFE STYLE DISEASE PREVENTION PROGRAMS

• FIVE YEAR PROGRAM ADVOCACY AND AWARENESS

• STANDARD SET OF SLIDES AND TRAINING MODULES FOR

PAEDIATRICIANS

• SCHOOL TEACHERS AND PARENTS

• PRE AND POST ASSESSMENT OF THE INTERVENTION

STRATEGIES

59

KEY MESSAGE

• INDIA : ALARMING EPIDEMICS OF T2 DM,CHD AND OTHER

LSD

• THE FOAD EPIDEMICS IS POTENTIALLY PREVENTABLE

WITH LIFE STYLE CHANGES IN CHILDHOOD AND

ADOLESCENCE

• TARGETED EFFECTIVELY THROUGH SCHOOL/COLLEGE

CAMPAIGNS TO FOCUS IN HEALTHY EATING, INCREASED

PHYSICAL ACTIVITY AND REDUCTION IN SEDENTARY

HABITS

60

AVAYAMA

DIVA

SWAPNA

SLESHMALA

AHARA SEVINA

ADHYASHA-NA

61

Nidana

sevana

Kapha

sanchaya

Anganam

gaurava,Aalsya62

Further indulgence in Kaphakaraahara-vihara

Aggravation of Kapha dosha along with production of aama anna rasa

Kapha dosha vriddhi 63

Due to nidana sevana

श्लेष्म प्रकोप

Vriddhi of medho dhatu,sanga in

medhovaha srotas

Vata prakopa and inturn jataragni

sandookshana

Atibhubhukshana inturn

medho datu vriddhi64

• DOSHA DUSHYA SAMURCHANA TAKES PLACE AT THIS STAGE.

• KAPHA SAMURCHANA TAKES PLACE WITH MEDO DHATU.

LEADING TO PRODROMAL SYMPTOMS SUCH AS

• GURU GHATRATVA

• SWEDA AABHADA

• ASAHASATVA

• TEEKSHNAGNI –KSHUDATI MATRA-PIPPASATIYOGA.

65

LEADING TO SYMPTOMS SUCH AS

• MEDO-MAMSA VRIDDHI

• CHALA SPHIK-UDARA-STANA

• AYATOPA CHAYOTSAHA

66

मेदोमाांसातिवदॄ्धत्वाश्चलतफिगुदरफिनः।

अयथोपचयोत्साहो नरो अतिफथूल उच्यिे ॥ (CHA.SU.21/9)

• MEDO-MAMSA VRIDDHI

• CHALA SPHIK-UDARA-STANA

• AYATOPA CHAYOTSAHA

अतिस्थूलस्य िावदायुषो ह्रासो जवोपरोधः कॄच्छ्रव्यवायिा दौर्बल्यं दौर्बन्ध्यंस्वेदार्ाधः क्षुदतिमात्रं पपपासातियोर्श्चेति भवन्ध्यष्टौ दोषाः ॥

(CH.SU.21/4)

• आयुषो ह्रास- DUE TO LACK OF POSHANA OF OTHER

DHATUS OTHER THAN MEDO DHATU.

• जवोपरोध -DUE TO SHARIRA SHAITILYA AND

SUKUMARATHA STHULA PERSONS ARE UTSAHA

RAHITA.

• कॄच्छ्रव्यवायत -DUE TO SHUKRA ALPATA AND AVRUTA

OF SHUKRA MARGA BY MEDO DHATU.

• दौर्बल्य - DUE TO VISHAMA DHATU VRIDDI.

• दौर्बन्ध्य - DUE TO ADIKA MEDA.

(DOURGANDHYA IN SWEDA)

• स्वेदार्ाध -DUE TO MEDA SWABHAVA.

• क्षुदततमात्रं - DUE TO TEEKSHA AGNI AND VAYU.

• पपपासाततयोर् - VAYU BAHULYATA IN KOSTA.

UPADRAVAS IN STHOULYA

Visar

paKushta

Bhaga

n-

dara

Jwara

Prame

-haAtisara

ArshaSleepa

d-a

KamalaApachi

• IT IS EASY TO PLUCK A PLANT WHEN IT IS

STILL A SAPLING, BUT IT IS DIFFICULT WHEN

IT BECOMES A TREE.

• IF SOME ATTENTION IS PAID TOWARDS THE

LIFESTYLE SEVERAL DISEASE CAN BE

PREVENTED SUCCESSFULLY..

• तदततस्थौल्यमततसम्पूरणाद्रु्रुमधुरशीतस्स्िग्धोपयोर्ादव्यायामादव्यवायाद्ददवास्वप्िाद्धषबतित्यत्वाद- चिन्धतिाद्र्ीजस्वभावाच्छ्िोपजायत|े

76

• आहारश्ि पवहारश्ि यः स्याद्दोषरु्ण ः समः| • धातुभभपवबरु्णश्िापप स्रोतसां स प्रदषूकः||२३||

77

• अततस्थूलस्य तावदायुषो ह्रासो जवोपरोधः [१] कृच्छ्रव्यवायता दौर्बल्यंदौर्बन्ध्यं स्वेदार्ाधः क्षुदततमात्रं पपपासाततयोर्श्िेतत भवन्धत्यष्टौ दोषाः|

78

• मेदोमांसाततवदृ्धत्वाच्छ्िलस्स्िरु्दरस्तिः| • अयथोपियोत्साहो [२] िरोऽततस्थूल उच्छ्यत|े|९||

79

• क्षुस्त्पपासातपसहः शीतव्यायामसंसहः| • समपक्ता समजरः सममांसियो मतः||१९||

80

• रु्रु िातपबणं िेष्टं स्थूलािां कशबिं प्रतत| • कृशािां र्ृंहणाथं ि लघु सन्धतपबणं ि यत|्|२०||

81

82