Finger Millet, A Highly Nutritious Cereal

Finger millet (Eleusine coracana, "Dagusa" in Amharic and "Ragi" in Kannada) is an annual plant in the grass family, widely grown in the arid regions of Africa and Asia. Finger millet is native to the Ethiopian Highlands, which was introduced into India approximately 4000 years ago. It is very adaptable to dry climate and grows in higher elevations up to 2,300 metres. It is grown as a cereal crop and a staple food in many regions of Africa and Asia.

Finger millet is often intercropped with legumes such as peanuts (Arachis hypogea), cowpeas (Vigna sinensis), and pigeon peas (Cajanus cajan) etc. It is estimated that finger millet is grown on approximately 38,000 km2. The seeds are stored extremely well and are not attacked by insects or moulds. It grows well without irrigation, pesticides, or fertilisers. The long storage capacity makes finger millet an important crop for poorer farming communities.

 
Finger millet is especially valuable in the amino acid methionine, which is lacking in other cereal crops, notably polished rice. It has the highest content of protein and calcium than any other cereal. It is digested easily from infancy through old age. It costs less than wheat, rice, or dairy milk while delivering superior nutrition. Finger millet can be ground and cooked into cakes, puddings or porridge. It is also used as a flavoured drink in festivals. The preparation made out of this cereal is considered as a weaning food for babies because of its high nutrition content. It is a good food for those with osteoporosis and other calcium deficient patients. Finger millet is an ideal food for obese people, because its digestion is slow and the carbohydrate takes longer time to get absorbed. It is an important crop for preventing malnutrition in rural communities in some developing countries. The straw from finger millet is used as an animal fodder.

The nutritive value of Ragi per 100 g is as follows:

Protein 7.3 g
Fat 1.3 g
Carbohydrate 72 g
Minerals 2.7 g
Calcium 3.44 g
Fibre 3.6 g
Energy 328 kCal

Preparation:
In India, finger millet (called locally as ragi) is mostly grown and consumed in Karnataka, Andhra Pradesh, Tamil Nadu, Maharashtra, and Goa. Ragi flour is made into flatbreads, including thick, leavened dosa and thinner, unleavened roti. Ragi grain is malted and the grains are ground. This ground flour is consumed mixed with milk, boiled water or yoghurt. In southern parts of India, pediatricians recommend finger-millet-based food for infants of six months and above because of its high nutritional content, especially Iron and calcium. Home made Ragi malt happens to be one of the most popular infant food even to this day. Sprouting ragi increases the bioavailability of its iron to 88%, comparable only to mother’s milk (and 8 times higher than cow’s milk).

Health Benefits of Ganoderma Lucidum Mushroom

Ganoderma Lucidum mushroom is known to cure various chronic diseases including organ diseases and cancer. It also slows down the aging process and prevent illnesses. Ganoderma is a genus of polypore mushooms which grow on wood and include about 80 species, mostly from the tropical regions. The name Ganoderma is derived from the Greek ganos "brightness, sheen", hence "shining" and derma "skin" and lucidum in Latin for "shining." As a fungus it is not capable of producing their own nutrient through photosynthesis such as green plants. They lead a parasitic life by surviving on nutrients of other plants and animals. Ganoderma are wood-decaying fungi with a cosmopolitan distribution, and can grow on both coniferous and hardwood species. They are white-rot fungi, and have enzymes that allow them to break down wood components such as lignin and cellulose.

Língzhi  is the name for one form of the mushroom Ganoderma lucidum, and its close relative Ganoderma tsugae. It is extensively used in traditional Asian Chinese medicine for more than 4,000 years for their potential for bioremediation and it is one of the oldest mushrooms known to have been used in medicine. An ancient medical practitioner Lee Shizhen from Ming Dynasty classified Ganoderma as the "superior herb" also known as the "King of Herbs." He grouped Ganoderma herb into six categories by its color and form, namely Green, Purple, Red, Yellow, White and Black Ganoderma. All six types have its own medicinal values and healing effects.

Description
Ganoderma are characterized by basidiocarps that are large, perennial, woody brackets, also called "conks". They are lignicolous, leathery, and either with or without a stem. The fruit bodies typically grow in a fanlike or hooflike form on the trunks of living or dead trees. They have double-walled, truncate spores with yellow to brown ornamented inner layers. It is a polypore mushroom which is soft when fresh, corky, and flat, with a conspicuous red-varnished, kidney-shaped cap and depending on the age, white to dull brown pores underneath. It lacks gills on its underside and releases its spores through fine pores and so is classified as a polypore.


Benefits

There are special healing properties of Ganoderma on circulatory system, nervous system, and immune system as well as anti-cancer effects. Ganoderma Lucidum has the an unusual combination of beneficial components such as Polysaccharides, Organic Germanium, Peroxide Dismutase, and Triterpenes.

It possess anti-tumor, immunomodulatory and immunotherapeutic activities, supported by studies on polysaccharides, terpenes, and other bioactive compounds isolated from fruiting bodies and mycelia. It has also been found to inhibit platelet aggregation, and to lower blood pressure, cholesterol, and blood sugar.

The mechanisms by which Ganoderma Lucidum may affect cancer are unknown and they may target different stages of cancer development: inhibition of angiogenesis mediated by cytokines, cytoxicity, inhibiting migration of the cancer cells and metastasis, and inducing and enhancing apoptosis of tumor cells.

Ganoderic acid  can help to strengthen the liver against liver injury by viruses and other toxic agents in mice, suggesting a potential benefit of this compound in the prevention of liver diseases in humans and Ganoderma-derived sterols inhibit lanosterol 14 alpha-demethylase activity in the biosynthesis of cholesterol.

Ganoderma is reported to exhibit direct anti-viral with the following viruses; HSV-1, HSV-2, influenza virus, vesicular stomatitis. Ganoderma mushrooms are reported to exhibit direct anti-microbial properties with the following organisms; Aspergillus niger, Bacillus cereus, Candida albicans, and Escherichia coli.

Ganoderma Lucidum also contains Polysaccharides which help to strengthen your immune system. Hence the stabilizing effects of Ganoderma can strengthen your health, improve your vitality and improve your immune system. These mushrooms can improve the immune system by activating Macrophages and Natural Killer (NK) cells. Macrophages are the important first line defence against virus, bacteria and foreign substances. NK cells are responsible to kill cancer cells in the body. Some can even improve allergic conditions such as skin allergy and asthma.


Extracted active components of Ganoderma can neutralize toxics in the body, reduce free radicals to slow down aging, and remove circulation blockage. Ganoderma can eliminate toxins accumulated in your body through intake of drugs. The organic Germanium in Ganoderma helps to enhance the ability of blood to take in more oxygen by 1.5 times. It also increases the metabolism rate and slow down the aging.


Availability
Ganoderma is available in capsules and liquid extracts, which can be found at health food stores. You can also take ganoderma in tea or coffee form, but the flavor may be bitter.

Medicinal Use
Usually 1 to 3 capsules of Ganoderma extract capsule per day is recommended for normal person and the dose can be increased from 3 to 6 capsules for those with serious and chronic health problems. Some people experience dry nose, dry throat, nausea, and gastrointestinal problems when taking Ganoderma, which is normal. Since the mushroom might interact with certain medications (such as anticoagulants and some chemotherapeutic agents), it is important to tell your physician when considering the use of Ganoderma. Please consult a registered medical practitioner before using it.

Festival of Onam in Kerala

Onam is a big cultural festival in the State of Kerala. It is a festival of flowers, songs, dances, games, and feast. Onam comes in the first month of the Malayalam calendar called Chingam or August/September months. It is celebrated as the homecoming of the legendary King Mahabali. It also marks as the Kerala's rice harvest festival and the festival of flowers. The weather is warm and sunny and the fields look bountiful during this time of the year and it is a time of plenty. It is also the boom time of fruits and flowers. The festivities lasts from four to ten days, which brings about the best of the culture of Kerala. First day, Atham and tenth day, Thiruonam are the most important. This is a Hindu festival that has crossed all barriers of creed, religion, or wealth which is celebrated by all and in all parts of Kerala and has gained the title of a State Festival. It is celebrated by people of different faiths in Kerala. All religions, castes, and communities celebrate the festival with equal joy and fervor. It is also the coming together of people from different political and social backgrounds which otherwise does not happen. Elaborate feasts, folk songs, elegant dances, energetic games, elephants, boats and flowers all are a part of the dynamic festival called Onam.

According to the legend and as it tells us, it is the annual visit of King Maveli (Mahabali) who is revered by all the people of Kerala from prehistory and during whose reign Kerala witnessed its golden era. The King was greatly respected in his kingdom and was considered to be wise, judicious and extremely generous. Everybody in the state was happy and prosperous and the king was highly regarded by his subjects. He was that much highly regarded among the subjects that even the Gods under Indra became jealous of Mahabali, they approached Mahavishnu claiming that Mahabali is now equivalent to an Indra. Since a world with two Indras represents imbalance, Mahavishnu assumed the form of a dwarf, the vamana avatara and tricked him to pathalam, the underworld. However, as Mahabali is equal to an Indra, he is to wait until the next yuga where he would be the Indra. In the meantime, with the grace of Mahavishnu, Mahabali visits his people on an annual basis. Mahavishnu serves Mahabali as a gatekeeper in the world of pathalam as the Lord himself serves his greatest devotees. This annual visit of Mahabali is celebrated as Onam every year. People celebrate the festival in a grand way and impress upon their dear King that they are happy and wish him well. Celebrations start with the lighting of the traditional lamp.

People believe that it is on the last day, Tiruonam that the spirit of King Maveli visits Kerala, hence the day is marked by feast and festivities. Devotees of Maveli celebrate the golden era witnessed in Maveli's reign during Onam. To welcome their revered ruler, people lay flower mats (Pookalam) in the front courtyard, prepare a grand meal (Onasadya), dance, play and make merry. All this is done to impress upon King Mahabali that his people are prosperous and happy.

The remarkable features of Onam are the decorated pookalam (floral carpets), kaikottikali(dance), vallamkali(snake boat races) onasadya(banquet lunch) etc. In this occasion, people wear new clothes and mostly dress traditional way(onakodi) distinct for men and women. Children have a lot to enjoy during this season with new clothes, toys, and anything they wished for during the season. Especially this is a holiday season totaling almost 10 days, and so everybody is on a vacation spirit, which is also a time for relatives from far and wide to share time with their dear ones.

This is also a time of great spending where all the shops and malls are flooded with new products and people come from all around the world. People wait for this special occasion when they get the most valuable products at reasonable prices. There are places where the prices touch the rock bottom where everyone have their share of joy and plenty. The most important part of Onam celebration is the grand feast called Onasadya, prepared on Thiruonam. It is a nine course meal consisting of 11 to 13 essential dishes. Onasadya is served on banana leaves and people sit on a mat laid on the floor to have the meal.

The weather is pleasant, warm, and sometimes a few occasional rains, which also coordinates with the autumn season in this part of the world. In this ten-day-long festive activities  that includes Pulikali, Kaikottikali, Kummattikalli, Kathakali, Thumbi Thullal besides several other folk arts and traditions that can be seen on one occasion called Onam. There are games and group sporting activities carried outside which includes the boat races,  pulikali etc. which everyone participates and win prizes.

If you are from a far away country, this is a special time to visit and spend your valuable time in Kerala and leave long lasting memories of this special occasion. I heartily invite you to spend your next vacation for celebrating Onam in Kerala.

The Essential Vitamins That we Need

Vitamins are organic substances which have to be supplied to the food in minute quantities to maintain the biochemical and structural integrity of many cells and tissues in an organism. It cannot be synthesized in sufficient quantities by an organism, and must be obtained from the diet. Most of them are integral parts of various coenzymes required for biochemical reactions at tissue levels. Vitamins are classified by their biological and chemical activity, not their structure. Thus, each "vitamin" refers to a number of vitamer compounds that all show the biological activity associated with a particular vitamin.

Vitamins have diverse biochemical functions. Some have hormone-like functions and act as regulators of mineral metabolism or regulators of cell and tissue growth and differentiation while others function as antioxidants. The largest number of vitamins function as precursors for enzyme cofactors, that help enzymes in their work as catalysts in metabolism. Alternately, vitamins may also be less tightly bound to enzyme catalysts as coenzymes, detachable molecules which function to carry chemical groups or electrons between molecules.
Vitamins are classified into fat-soluble and water-soluble groups. In humans there are 13 important vitamins the 4 fat-soluble vitamins are vitamins A, D, E and K and the 9 water-soluble vitamins are vitamin C and 8 B-vitamins.

The 4 fat soluble vitamins are:
1) Vitamin A (Retinol)
2) Vitamin D (Calciferol)
3) Vitamin E (Tocopherol)
4) Vitamin K (Phylloquinone)
Water 9 soluble vitamins are:
1) Vitamin C (Ascorbic acid)
2) The 8 B-complex vitamins.

Water-soluble vitamins dissolve easily in water, and in general, are readily excreted from the body, to the degree that urinary output is a strong predictor of vitamin consumption. As the water soluble vitamins are not readily stored, consistent daily intake is important. Many types of water-soluble vitamins are synthesized by bacteria. The B-complex vitamins consists of thiamine, niacin, riboflavin, pyridoxin, biotin, cyanacobalamin, inositol, folic acid, and pantothenic acid. Vitamins are classified by their biological and chemical activity and not their structure. The term vitamin is conditional both on the circumstances and the particular organism, such as the ascorbic acid (vitamin C) is a vitamin for humans and not for most other animals and biotin and vitamin D are required in the human diet only in certain circumstances.

Functions of vitamins include regulators of mineral metabolism e.g. vitamin D, regulators of cell and tissue growth and differentiation e.g. vitamin A, function as antioxidants e.g. vitamin E and vitamin C, function as precursors for enzyme cofactors, that help enzymes in their work as catalysts in metabolism e.g. B complex vitamins.

Vitamin A (Retinol):

It is a fat soluble vitamin.All forms of vitamin A have a beta-ionone ring to which an isoprenoid chain is attached, called a retinyl group. Both structural features are essential for vitamin activity. The orange pigment of carrots - beta-carotene - can be represented as two connected retinyl groups, which are used in the body to contribute to vitamin A levels.
Functions: Vitamin A has a major role in normal visual processes and maintenance of health of epithelial cells. The chemical names are retinol, retinal, and four carotenoids including beta carotene. Vitamin A is needed by the retina of the eye in the form of a specific metabolite, the light-absorbing molecule retinal. This molecule is absolutely necessary for both scotopic and color vision. Vitamin A is necessary for the function of the reproductive systems of both male and female mammals. Vitamin A also functions in a third and very different role, as an irreversibly oxidized form retinoic acid, which is an important hormone-like growth factor for epithelial and other cells.
Dietary requirement: The recommended daily dietary requirement for adult is 900 micrograms. Deficiency of vitamin A is one of the major causes of preventable blindness such as night-blindness and keratomalacia. The overdose of this vitamin is called hypervitaminosis A or hypercarotenemia due to excessive intake of carrots, fish liver etc.

Sources: Vitamin A is exclusively found in animal foods. Rich sources are liver especially fish liver, butter, ghee, cheese, egg yolk, and milk. Vegetable sources contain the precursor of vitamin A carotene. Rich sources of carotene are dark green vegetables such as spinach, amaranth, yellow vegetables like carrot, pumpkin, and fruits like mangoes and papaya.

Vitamin D (Calciferol):

Vitamin D is a group of fat-soluble secosteroids, the two major physiologically relevant forms of which are vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol).
Functions: Vitamin D is required for normal metabolism of calcium and phosphorus and for bone formation. It enhances the absorption of calcium and phosphorus from the small intestine, increase mobilization of calcium from bone, and the reabsorption of calcium and phosphorus from the kidneys.

The two major physiologically relevant forms of vitamin D are vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Vitamin D2 is obtained from the diet. Vitamin D3 is produced in the skin of vertebrates after exposure to ultraviolet B light from the sun or artificial sources, and also occurs naturally in some foods. Vitamin D2 (ergocalciferol) obtained by ultraviolet irradiation of ergosterol or ergocalciferol provitamin D2 which is formed by activation of 7-dehydrocholesterol present in the epidermal cells of human skin as a provitamin D2. This activation is affected by the ultraviolet rays ranging in wavelength from 296 A to 310 A obtained from sunlight naturally.
Vitamin D obtained from sun exposure, food, and supplements is biologically inert and must undergo two hydroxylations in the body for activation. Vitamin D is carried in the bloodstream to the liver, where it is converted into the prohormone calcidiol. Circulating calcidiol may then be converted into calcitriol, the biologically active form of vitamin D, either in the kidneys or by monocyte-macrophages in the immune system. When synthesized by monocyte-macrophages, calcitriol acts locally as a cytokine, defending the body against microbial invaders. Vitamin D2 is obtained from the diet and the vitamin D3 is formed endogenously. These two sources complement each other in providing the total supply of vitamin D.
Dietary requirement: The recommended daily dietary requirement for adult is 5.0–10 micrograms. The minimum daily requirement is 400 IU. Deficiency of vitamin D results in impairment of mineralization of bone leading to nutritional rickets in children and osteomalacia in adults. Overdose causes hypervitaminosis D.
Sources: The flesh of fish (such as salmon, tuna, and mackerel) and fish liver oils are among the best sources. Some amount of vitamin D is found in milk, butter, cheese, egg yolk, beef liver, and fish liver oils.

Vitamin E (Tocopherol):
Vitamin E is a generic term for tocopherols and tocotrienols. Vitamin E is a family of alpha, beta, gamma, and delta tocopherols and corresponding four tocotrienols.
Functions: Vitamin E is a strong fat-soluble antioxidant that stops the production of reactive oxygen species formed when fat undergoes oxidation. It prevents the peroxidation of cellular and subcellular membrane phospholipids. It is involved preserving the integrity of cell membranes. It has been claimed that α-tocopherol is the most important lipid-soluble antioxidant, and that it protects cell membranes from oxidation by reacting with lipid radicals produced in the lipid peroxidation chain reaction. This would remove the free radical intermediates and prevent the oxidation  reaction from continuing. The oxidised α-tocopheroxyl radicals produced in this process may be recycled back to the active reduced form through reduction by other antioxidants, such as ascorbate, retinol or ubiquinol.

Dietary requirement: The recommended daily dietary requirement for adult is 15.0 mg. Deficiency is very rare; mild hemolytic anemia in newborn infants. Vitamin deficiency leads to infertility. Vitamin E deficiency causes neurological problems due to poor nerve conduction. These include neuromuscular problems such as spinocerebellar ataxia and myopathies. Deficiency can also cause anemia, due to oxidative damage to red blood cells. Overdose causes increased chance of congestive heart failure.
Sources: Particularly high levels of vitamin E can be found in Avocado, eggs, milk, nuts such as almonds, hazelnuts, seeds, spinach and other green leafy vegetables, unheated vegetable oils, wheat germ, wholegrain foods etc.

Vitamin K (Phylloquinone):
Vitamin K1 is also known as phylloquinone or phytomenadione (also called phytonadione). Vitamin K2 (menaquinone, menatetrenone) is normally produced by bacteria in the large intestine.
Functions: Vitamin K denotes a group of lipophilic, hydrophobic vitamins that are needed for the posttranslational modification of certain proteins, mostly required for blood coagulation, but also a number of other proteins that chelate calcium ions and are involved in bone and other tissue metabolism.
Functions: Vitamin K is involved in the carboxylation of certain glutamate residues in proteins to form gamma-carboxyglutamate residues (abbreviated Gla-residues). They play key roles in the regulation of three physiological processes such as blood coagulation, bone metabolism, and vascular biology. Average diets are usually not lacking in vitamin K and primary vitamin K deficiency is rare in healthy adults. Dietary deficiency is extremely rare unless the intestines are heavily damaged, are unable to absorb the molecule, or are subject to decreased production by normal flora, as seen in broad spectrum antibiotic use. Newborn infants are at an increased risk of deficiency. Other populations with an increased prevalence of vitamin K deficiency include individuals who suffer from liver damage or disease (e.g. alcoholics), people with cystic fibrosis, inflammatory bowel diseases or those who have recently had abdominal surgeries. Groups that may suffer from secondary vitamin K deficiency include bulimics, those on stringent diets, and those taking anticoagulants.
Dietary requirement: The recommended daily dietary requirement for adult is 120 microgram. Deficiency disease cause bleeding diathesis. Overdose increases coagulation in patients taking warfarin drug.
Sources: Vitamin K1 is found chiefly in leafy green vegetables such as spinach, cabbage, kale, cauliflower, broccoli, and brussels sprouts, some fruits such as avocado and kiwifruit are also high in vitamin K.

Vitamin C (Ascorbic acid):
Vitamin C or L-ascorbic acid or L-ascorbate is an essential nutrient for humans and certain other animal species, in which it functions as a vitamin.
Functions: In living organisms, ascorbate is an anti-oxidant, since it protects the body against oxidative stress. It is also a cofactor in at least eight enzymatic reactions, including several collagen synthesis reactions that cause the most severe symptoms of scurvy when they are dysfunctional. These reactions are especially important in wound-healing and in preventing bleeding from capillaries. Ascorbate (an ion of ascorbic acid) is required for a range of essential metabolic reactions in all animals and plants. The uses and recommended daily intake of vitamin C range from 45 to 95 mg/day. Proponents of megadosage  propose from 200 mg to more than 2000 mg/day. The fraction of vitamin C in the diet that is absorbed and the rate at which the excess is eliminated from the body vary strongly with the dose. The human body can store only a certain amount of vitamin C, and so the body stores are depleted if fresh supplies are not consumed. The time frame for onset of symptoms of scurvy in unstressed adults switched to a completely vitamin C free diet, however, may range from one month to more than six months, depending on previous loading of vitamin C.

Dietary requirement: The recommended daily dietary requirement for adult is 90.0 mg.
Deficiency of vitamin C causes the disease scurvy in humans. In lack of this vitamin, the synthesised collagen is too unstable to perform its function. Scurvy leads to the formation of brown spots on the skin, spongy gums, and bleeding from all mucous membranes. The spots are most abundant on the thighs and legs, and a person with the ailment looks pale, feels depressed, and is partially immobilized. In advanced scurvy there are open, suppurating wounds and loss of teeth and, eventually, death. Over dose of vitamin C is called vitamin C megadosage.

Sources: The richest natural sources are fruits and vegetables and of those, the Kakadu plum, the camu camu  fruit, rose hip contain the highest concentration of the vitamin. Fruits such as gooseberry, orange, grape fruit, lemon, passion fruit etc. also contains a high concentration of it. It is also present in some cuts of meat, especially liver.

 

Vitamin B Complex:
The important B vitamins are eight water-soluble vitamins that play important roles in cell metabolism.  The B complex vitamins are:
1. Vitamin B1 (Thiamine)
2. Vitamin B2 (Riboflavin)
3. Vitamin B3 (Niacin or niacinamide)
4. Vitamin B5 (Pantothenic acid)
5. Vitamin B6 (Pyridoxine, pyridoxal, or pyridoxamine)
6. Vitamin B7 (Biotin)
7. Vitamin B9 (folic acid)
8. Vitamin B12 (various cobalamins; commonly cyanocobalamin)

The B vitamins are necessary to support and increase the rate of metabolism, maintain healthy skin and muscle tone, enhance immune and nervous system function, promote cell growth and division, including that of the red blood cells that help prevent anemia, reduce the risk of pancreatic cancer when consumed in food etc.

Vitamin B1(Thiamine)
Deficiency causes beriberi. Symptoms of this disease of the nervous system include weight loss, emotional disturbances, Wernicke's encephalopathy (impaired sensory perception), weakness and pain in the limbs, periods of irregular heartbeat, and edema (swelling of bodily tissues). Heart failure and death may occur in advanced cases.
Dietary requirement: The recommended daily dietary requirement for adult is 1.2 mg. Deficiency causes Beriberi and Wernicke-Korsakoff syndrome. Overdose produce drowsiness or muscle relaxation usually with large doses.
Vitamin B2 (Riboflavin)
Deficiency causes ariboflavinosis. Symptoms may include cheilosis (cracks in the lips), high sensitivity to sunlight, angular cheilitis, glossitis (inflammation of the tongue), seborrheic dermatitis or pseudo-syphilis (particularly affecting the scrotum or labia majora and the mouth), pharyngitis, hyperemia, and edema of the pharyngeal and oral mucosa.
Dietary requirement: The recommended daily dietary requirement for adult is 1.3 mg.
Vitamin B3 (Niacin)
Deficiency, along with a deficiency of tryptophan causes pellagra. Symptoms include aggression, dermatitis, insomnia, weakness, mental confusion, and diarrhea. In advanced cases, pellagra may lead to dementia and death.
Dietary requirement: The recommended daily dietary requirement for adult is  16.0 mg. Overdose causes Liver damage and other problems.
Vitamin B5 (Pantothenic acid)
Deficiency can result in acne and paresthesia.
Dietary requirement: The recommended daily dietary requirement for adult is 5.0 mg. Overdose cause diarrhea, possibly nausea and heartburn.
Vitamin B6 (Pyridoxine)
Deficiency may lead to microcytic anemia, depression, dermatitis, high blood pressure, water retention, and elevated levels of homocysteine.
Dietary requirement: The recommended daily dietary requirement for adult is  1.3–1.7 mg. Higher dose causes impairment of proprioception and nerve damage.
Vitamin B7 (Biotin)
Deficiency does not typically cause symptoms in adults but may lead to impaired growth and neurological disorders in infants. Deficiency causes dermatitis and enteritis. Multiple carboxylase deficiency, an inborn error of metabolism, can lead to biotin deficiency even when dietary biotin intake is normal.
Dietary requirement: The recommended daily dietary requirement for adult is 30.0 microgram.
Vitamin B9 (Folic acid)
Deficiency results in a macrocytic anemia, and elevated levels of homocysteine. Deficiency in pregnant women can lead to birth defects. Supplementation is often recommended during pregnancy.
Dietary requirement: The recommended daily dietary requirement for adult is  400 microgram. Overdose of it may mask symptoms of vitamin B₁₂ deficiency and other effects.
Vitamin B12 (Cobalamin)
Deficiency results in megaloblastic anemia, elevated homocysteine, peripheral neuropathy, memory loss and other cognitive deficits. It is most likely to occur among elderly people, as absorption through the gut declines with age; the autoimmune disease pernicious anemia is another common cause. It can also cause symptoms of mania and psychosis.
Dietary requirement: The recommended daily dietary requirement for adult is 2.4 microgram.

Sources: B vitamins are found in all whole, unprocessed foods. Processed carbohydrates, such as sugar and white flour, tend to have lower B vitamin content than their unprocessed counterparts. B vitamins are particularly concentrated in meat and meat products such as liver, turkey, and tuna. Other good sources for B vitamins are whole grains, potatoes, bananas, lentils, chile peppers, tempeh, beans, nutritional yeast, brewer's yeast, and molasses. The B12 vitamin is of note because it is not available from plant products, making B12 deficiency a concern for vegans.

Hope it helps you in determining the necessary ingredients needed for a balanced diet. Please also do note that it is not advisable to take more than what is needed. Consult a physician for further calculating the dietary value and management of your daily diet style.

Why Do we Yawn and What are The Reasons

What is yawning
Yawning is a reflex opening of mouth and simultaneous deep inhalation of air and stretching of the eardrums, followed by slow exhalation of breath. It is an involuntary action that we do without our consciousness, which causes us to open our mouths wide and breathe in deeply. When yawning includes stretching also , it is called pandiculation. We do yawn even when we are still in our mother's womb. Yawning can also be a powerful non-verbal message with different meanings depending on the circumstances. Yawning has an infectious quality (imitation) in humans like observing another person's yawning face, looking at a yawning picture, or just thinking of yawning can trigger a person to yawn, which is a typical example of a positive feedback. Yawning in animals serve as a warning signal, display of anger, aggressive attack, courtship ritual, confusion, and other physiological reasons.

Causes of human yawning
1. Drowsiness or weariness.
2. Excessive tiredness or boredom.
3. Disorder associated with excessive daytime sleepiness.
4. Panic.
5. Imitation.

Reason behind yawning
There are various theories put forward to describe yawning such as a) Physiological theory. b) Cooling of brain theory. c) Evolution theory. d) Boredom theory etc.
According to the brain cooling theory, yawning cools the brain when it is overheated. The brain is able to function at its best when it is cool and humans and other animals have evolved adaptations to accommodate this. Very often, when we are tired or under stress, we keep yawning all the time. It is caused as the deep brain temperature is increased, when the person is exhausted or sleep deprived. Yawning cools and alerts the brain.

Yawning is  induced when the level of glucose supplied to the brain decreases such as in the state of hunger. It is also thought to be a mechanism to clear the lymphatic system before and after sleep. Another assumption in this regard is that yawning is caused by some chemicals found in the brain, like, serotonin, dopamine, glutamine, glutamic acid and nitric oxide. These chemicals are also responsible for affecting emotions, mood, appetite and certain other states. Activation of these chemicals in the brain is found to increase the frequency of yawns, while some other chemicals such as opioid neurotransmitters, e.g., endorphins, can reduce yawning.

The cause for contagious yawning (imitative yawning) may lie with mirror neurons that are neurons in the frontal cortex of certain vertebrates, which upon being exposed to a stimulus from the same species and occasionally interspecific organisms, activates the same regions in the brain. Mirror neurons have been proposed as a driving force for imitation which lies at the root of much human learning, e.g., language acquisition. Yawning may be an offshoot of the same imitative impulse.

Yawning in animals

Baboons yawn to threaten their enemies by displaying large canine teeth. A Siamese fighting fish yawn only when they see a their same species or their own mirror-image, and their yawn often accompanies aggressive attack. Guinea pigs also yawn in a display of dominance or anger displaying their impressive incisor teeth.Adelie Penguins yawn as a part of their courtship ritual. Penguin couples face off and the males engage in an ecstatic display. Snakes yawn to realign their jaws after a meal and for respiratory reasons. Dogs often yawn after seeing people yawn, and when they are confused. Fish can also yawn, and they increase this behavior due to lack of oxygen or excessive heat. Infectious yawning has also been noted in chimpanzees especially for psychological reasons and contagious yawning may have developed as a way to keep a group of animals alert.

What is Bruxism and How to Prevent it

Definition
Bruxism is gnashing or clenching of the teeth, which is holding tight your upper and lower tooth together and sliding back and forth over each other. It is characterized by habitual grinding of the teeth and is typically accompanied by the clenching of the jaw. It is an oral parafunctional activity that occurs in most humans and is mild enough not to cause any health problems. In some people it is severe enough to cause discomfort and seek treatment. Bruxism can be diurnal or nocturnal in nature and bruxism during sleep causes most of the health issues. It is one of the most common sleep disorders.

 
Causes
Bruxism is a subconscious process and during sleep the subconscious processes become active, while the higher control is inactive, resulting in bruxism. People clench or grind the teeth without being aware of it during the day or night, although sleep-related bruxism is often the bigger problem as it is harder to control. There are several factors contributing to bruxism and these factors depend from individual to individual.
1.    Daily stress.
2.    Misalignment of tooth and oral structures.
3.    Diet.
4.    Posture.
5.    Ability to relax.
6.    Sleeping habits and comfort.

Signs
In most people bruxism does not cause problems and in about 5% individuals it develops symptoms such as jaw pain and headaches, which requires treatment. Bruxism can result in abnormal wear patterns of the grinding surface of the tooth and also causes abrasions and fractures of the teeth. This is also called as occlusal trauma. It also causes significant tooth loss and gum recession. In most of the cases, the canines and incisors of the opposing arches are moved against each other laterally. This movement abrades tooth structure and can lead to the wearing down of the incisal edges of the teeth. People with bruxism may also grind their posterior teeth, which will wear down the cusps of the occlusal surface.

Symptoms
Clenching the teeth puts pressure on the muscles, tissues, and other structures around the jaw. The symptoms can cause temporomandibular joint (TMJ) problems. Patients may present with a variety of symptoms, that includes
1.    Anxiety, stress, and tension
2.    Depression
3.    Ear ache
4.    Tooth sensitivity.
5.    Eating disorders
6.    Headache
7.    Insomnia
8.    Sore or painful jaw

Sequelae
Bruxism shortens and blunts the teeth by grinding, which reduces the vertical height of the teeth that leads to myofascial muscle pain, eating disorders, temporomandibular joint dysfunction, headaches, insomnia etc.

Exams and Tests
An examination can rule out other disorders that may cause similar jaw pain or ear pain, including:
1.    Dental decay and other disorders.
2.    Ear disorders such as ear infections
3.    Problems with the temporomandibular joint (TMJ)

Treatment
Bruxism may be reduced or eliminated when the associated causative factors are treated successfully. The goals of the treatment are to prevent damage to the teeth, reduce pain, and reduce clenching as much as possible. These can be accomplished by
1.    Avoid eating hard foods like nuts, candies, steak.
2.    Drink plenty of water every day.
3.    Get plenty of sleep.
4.    Relax your face and jaw muscles throughout the day, promote facial relaxation.
5.    Physical therapy stretching exercises to help restore a normal balance to the action of the muscles and joints on each side of the head.
6.    Massage the muscles of the neck, shoulders, and face.
7.    Try to reduce your daily stress and learn relaxation techniques.
8.    Wearing of mouth guards and splints during night.
9.    Nociceptive trigeminal inhibitor.
10.    Biofeedback devices.
11.    Dietary supplements which reduces the causes of bruxism.
12.    Repairing damage to the tooth.

Bruxism Complications
1.    It can cause permanent damage to the teeth and uncomfortable jaw pain, headaches, or ear pain.
2.    Depression
3.    Increased dental or TMJ problems.
4.    Nightly grinding can awaken roommates and sleeping partners.

Hope you got an idea on how to deal with a case of bruxism.

Benefits of Yoghurt

The health benefits of yogurt have been noted for centuries and many people still do not realize how valuable yogurt is for a healthy lifestyle. People have been making and taking yogurt in their diet for almost 5,400 years. Today, it is a common food item around the world. Yogurt is a nutritious food with unique health benefits, it is rich in protein, calcium, riboflavin, vitamin B6 and vitamin B12. The most outstanding benefit of the yogurt comes from the way the yogurt is made.

Yogurt is a dairy product produced by bacterial fermentation of milk. Fermentation of lactose produces lactic acid, which acts on milk protein to give yoghurt its texture and character. Yogurt is produced using a culture of Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus salivarius subsp. thermophilus bacteria (active live cultures). The milk is heated to about 80°C to kill any undesirable bacteria and also to change the milk proteins so that they set together rather than form curds. It is then cooled to about 45°C. The bacteria culture is added, and this temperature is maintained for 4 to 7 hours for fermentation. Cultures are composed of unique living microorganisms especially Lactobacillus, which are responsible for many of the health and nutritional benefits of yogurt.

1. The active live cultures in the yogurt are the key to many of its health benefits. Active live cultures are basically good bacteria that are necessary for the body to function at its best. These good bacteria prevent the growth of harmful bacteria that cause bacterial infections and diseases. Healthy levels of good bacteria also promote digestive health and boost the immune system. It improves natural defense and may also help to boost the immune system. They encourage the right kind of bacteria to multiply in the gut. These bacteria help to digest food and prevent stomach infections.
2. Good bacteria prevent imbalances in the body’s yeast levels, which can prevent various types of yeast infections. It has also been shown that good bacteria can prevent urinary tract infections. Eating yogurt regularly can help restore your good bacteria levels. They also help to provide relief from vaginal infections. Taking antibiotics can destroy the good bacteria present in the body.

3. Since yogurt is made from dairy products it is very high in calcium, which is beneficial for bone and teeth development. Calcium is especially important for those who want to prevent loss of bone density and osteoporosis. Good amount of calcium is essential for healthy teeth and bone growth in children. Healthy levels of calcium can also encourage the body to maintain and lose weight.

4. Yogurt is also a good source of protein, which helps to provide muscle buildup and also energy to keep you working throughout the day. Protein is an essential building block for many body systems including the muscles. Protein is also good for curbing your appetite and helping you feel full for a longer period of time.

5. Some people have trouble digesting lactose, which is a carbohydrate present in milk and milk products, because of the deficiency of enzyme lactase in the body. Live yogurt cultures produce lactase that break down the lactose. It reduces the yogurt’s level of lactose which in turn makes yogurt a delicious dairy alternative for those who are lactose intolerant. Yogurt is a healthy way to get the body calcium needs for the people who can not tolerate milk products.

Yogurt is fresh dairy product that must be stored in the refrigerator. Heat treating the yogurt destroys the cultures and so does not give nutritional benefits. The more active cultures that are present in the yogurt, the more benefits you receive from it.

Yoghurt is usually eaten plain along with main dishes like stuffed cabbage and spinach. Yoghurt can be mixed with salads. You can also prepare yogurt drinks made with plain yogurt, salt and water. Fried vegetables such as eggplant or zucchini are eaten with yogurt. Cucumber and yogurt salad is very popular among the Mediterranean countries, it is prepared with yogurt, cucumbers, fresh or dried mint, garlic and salt.

Diabetes Causes Symptoms and Management

Diabetes

Diabetes is a condition in which the person has constant high levels of blood sugar (glucose) content. This may be due to insufficient production of insulin in the body or the body is not responding to the effects of insulin due to several factors and conditions. Glucose in the blood is produced by the liver breaking down food we eat, which gives us energy to perform daily activities. Human body has to maintain the blood glucose level at a very narrow range, which is done with the hormones insulin and glucagon. Insulin is one of the main hormones that regulates blood sugar levels and allows the body to use sugar ( glucose) for energy. Insulin is produced by pancreas, a small organ between the stomach and liver.
 
Diabetes mellitus is a major form of metabolic disorder characterized by hyperglycemia (increased blood sugar) with or without glycosuria (increased urine sugar). This is one of the most widespread disorder affecting mankind. It is mostly considered as an urban disease. The chance of getting diabetes mellitus is increased with increase in the age of the person. There are genetic factors, which contribute to the susceptibility of an individual to diabetes mellitus. Ethnic differences also occur in the prevalence of diabetes mellitus. The incidence is increasing recently around the world.

 
Major types of diabetes mellitus:
1.  Prediabetes.
2.  Type 1 diabetes.
3.  Type 2 diabetes.
4.  Gestational diabetes.
5.  Metabolic syndrome.


1. Prediabetes: It is a common condition related to diabetes whereas the blood sugar level is higher than normal but not high enough to be considered diabetic. Prediabetes is a precursor of developing diabetes and it increases the risk of developing type 2 diabetes, heart disease, and stroke. Pre-diabetes can be reversed without insulin or medication by losing a modest amount of weight and increasing your physical activity. This weight loss can prevent, or at least delay, the onset of type 2 diabetes.
2. Type 1 diabetes: It is also called as insulin dependent diabetes mellitus (IDDM) or juvenile onset diabetes mellitus. The body stops producing insulin or produces too little insulin to regulate blood glucose level. Type 1 diabetes is typically recognized in childhood or adolescence. Type 1 diabetes can occur in an older individual due to destruction of pancreas by alcohol, disease, or removal by surgery. It also results from progressive failure of the pancreatic beta cells, which produce insulin. People with type 1 diabetes require daily insulin treatment to sustain life.
3. Type 2 diabetes: It is also called as non insulin dependent diabetes mellitus (NIDDM). The pancreas secretes insulin, but the body is partially or completely unable to use the insulin. This is sometimes referred to as insulin resistance. The body tries to overcome this resistance by secreting more and more insulin. People with insulin resistance develop type 2 diabetes when they do not continue to secrete enough insulin to cope with the higher demands. Type 2 diabetes is typically recognized in adulthood, usually after age 45 years. It used to be called adult-onset diabetes mellitus, or non-insulin-dependent diabetes mellitus.
4. Gestational diabetes: It is a form of diabetes that occurs during the second half of pregnancy. Although gestational diabetes typically goes away after delivery of the baby. Women who have gestational diabetes are more likely than other women to develop type 2 diabetes later in life. Women with gestational diabetes are more likely to have large babies.
5. Metabolic syndrome: It is also called syndrome X, which is a set of abnormalities with insulin-resistant diabetes (type 2 diabetes). It is always presenting along with hypertension, hyperlipidemia, elevation of LDL cholesterol, decreased HDL cholesterol, elevated triglycerides, central obesity, and abnormalities in blood clotting and inflammatory responses. A high rate of cardiovascular disease is associated with the metabolic syndrome.


Causes:
In type 1 diabetes, the absolute lack of insulin usually secondary to a destructive process affecting the insulin producing beta cells in the pancreas is the main disorder. Type 1 diabetes is believed to be an autoimmune disease. The body's immune system attacks the cells in the pancreas that produce insulin. A predisposition to develop type 1 diabetes may run in families. Environmental factors, include common viral infections. Its prevalence also runs through certain human races such as Northern Europeans etc.

In type 2 diabetes there is insufficient production of insulin to the body's needs, production of defective insulin, or the inability of cells to use insulin properly and efficiently leads to hyperglycemia and diabetes. Type 2 diabetes has strong genetic links and tends to run in families.


Risk Factors for developing diabetes:
1. High blood pressure.
2. High blood triglyceride levels.
3. High-fat diet.
4. High alcohol intake.
5. Sedentary lifestyle.
6. Obesity or overweight.
7. Gestational diabetes.
8. Ethnicity.
9. Aging.

Symptoms of diabetes:

1. Increased fatigue.

2. Unexplained weight loss.
3. Thirst (polydipsia).
4. Dry mouth.
5. Frequent urination (polyuria).
6. Increased hunger (polyphagia).
7. Blurred vision.
8. Labored and heavy breathing.
9. Poor wound healing.
10. Iinfections.
11. Altered mental status.
12. Blurry vision.
13. Loss of consciousness.
Other symptoms may include slow-healing sores or cuts, itching of the skin, yeast infections, recent weight gain, numbness or tingling of the hands and feet, impotence or erectile dysfunction.

How it is detected and when to seek medical care:
1. When the patient is experiencing above mentioned diabetes symptoms and there is high blood sugar. The patient's blood sugar levels, when tested, are consistently high (more than 200 mg/dL).
2. When the patient's blood sugar level is low (less than 60 mg/dL), hypoglycemia due to over use of insulin. It  may also be a sign of infection or other stress on the system such as kidney failure, liver failure, adrenal gland failure, or the concomitant use of certain medications.
3. When the patient has an injury to the foot or leg, no matter how minor. Even the tiniest cut or blister can become very serious in a person with diabetes.
4. When the patient has a low-grade fever (less than 101.5°F). Fever is a sign of infection. In patients with  diabetes, many common infections can potentially be more dangerous for them than for other people.
5. The patient is nauseated or vomiting but can keep liquids down.


1999 WHO Diabetes criteria:
Condition                                   2 hour glucose     Fasting glucose
                                                  mmol/l(mg/dl)     mmol/l(mg/dl)
Normal                                       <7.8 (<140)     <6.1 (<110)
Impaired fasting glycaemia           <7.8 (<140)     = 6.1(=110) & <7.0(<126)
Impaired glucose tolerance          =7.8 (=140)     <7.0 (<126)
Diabetes mellitus                        =11.1 (=200)     =7.0 (=126)

Complications of diabetes:
1. Hyperglycemia: Diabetes ultimately lead to high blood sugar levels, a condition called hyperglycemia. Over a long period of time, hyperglycemia damages the retina of the eye, the kidneys, the nerves, and the blood vessels.
2. Insulin resistance: In pancreas the beta cells of the islets of Langerhans show reduction in number, degranulation, and hyalinization. Resistance to insulin develops in the target cells due to receptor insensitivity.
3. Vascular changes: Diabetes has a predisposition to develop vascular lesions affecting small and large vessels. In microangiopathy, there is a specific involvement of the small blood vessels, venules, capillaries, and arteries are affected. Microangiopathy affects several organ systems and the main lesions are seen in the retina, kidneys, peripheral nerves, and heart giving rise to diabetic retinopathy, diabetic neuropathy, and cardiomyopathy. Damage to the retina from diabetes (diabetic retinopathy) is a leading cause of blindness.
4. Atherosclerosis: Diabetes accelerates atherosclerosis, (the formation of fatty plaques inside the arteries), which can lead to blockages or a clot (thrombus). Such changes can then lead to heart attack, stroke, and decreased circulation in the arms and legs (peripheral vascular disease).
5. Nerve damage: Damage to the nerves from diabetes (diabetic neuropathy) is a leading cause of foot wounds and ulcers, which frequently lead to foot and leg amputations. Damage to the nerves in the autonomic nervous system can lead to paralysis of the stomach (gastroparesis), chronic diarrhea, and an inability to control heart rate and blood pressure during postural changes.
6. Renal lesions: This is seen in patients with advanced diabetes. These changes include vascular changes such as 1) arteriosclerosis of the renal artery, 2) sclerosis of the arteries, and 3) glomerulonephrosis. There is thickening of the glomerular capillary basement membrane. The evidence of glomerulonephrosis is established by the presence of proteinuria. Damage to the kidneys from diabetes (diabetic nephropathy) is a leading cause of kidney failure.


Diabetic emergencies:
In case of an emergency the patient should be accompanied by a companion, bring a list of all medical problems, medications, allergies to medications, and the blood sugar diary to the emergency department.

Diabetic Tests:
1. Thorough medical interview and physical examination: The healthcare questionnaire includes symptoms, risk factors for diabetes, past medical problems, current medications, allergies to medications, family history of diabetes or other medical problems such as high cholesterol or heart disease, and personal habits and lifestyle.
2. Finger stick blood glucose: This is a rapid screening test and may be performed anywhere, including community-based screening programs where the result is available right away. A fingerstick blood glucose test is not as accurate as testing the patient's blood in the laboratory.
3. Fasting plasma glucose: The patient will be asked not to eat or drink for 8 hours before the blood is drawn. If the blood glucose level is greater than or equal to 126 mg/dL after fasting, then they probably have diabetes. If fasting plasma glucose level is greater than 100 but less than 126 mg/dL, then the patient has impaired fasting glucose, or IFG. This is considered to be pre-diabetes. If the result is abnormal, the fasting plasma glucose test may be repeated on a different day to confirm the result.
4. Oral glucose tolerance test: This test involves drawing blood for a fasting plasma glucose test, then drawing blood for a second test two hours after drinking a very sweet drink containing 75 grams of sugar. If the blood sugar level after the sugar drink is greater than or equal to 200 mg/dL, the patient has diabetes. If the blood glucose level is between 140 and 199, then the patient has impaired glucose tolerance (IGT), which is a pre-diabetic condition.
5. Glycosylated hemoglobin or hemoglobin A1c: This test is a measurement of how high the blood sugar levels have been over the last 120 days. Excess blood glucose hooks on to the hemoglobin in red blood cells and stays there for the life of the red blood cell. A hemoglobin A1c test is the best measurement of blood sugar control in people known to have diabetes. A hemoglobin A1c result of 7% or less indicates a good glucose control. A result of 8% or greater indicates that blood sugar levels are too high for too much of the time.

Diagnosing complications of diabetes:
1. The patient should have their eyes checked at least once a year by an eye specialist to screen for diabetic retinopathy, a leading cause of blindness.
2. The patient's urine should be checked for microalbumin on a regular basis, at least one to two times a year. Protein in the urine is an early sign of diabetic nephropathy, a leading cause of kidney failure.
3. Sensation in the legs should be checked regularly using a tuning fork or a monofilament device. The healthcare provider should check the feet and lower legs at every visit for cuts, scrapes, blisters, or other lesions that could become infected.
4. The patient should be screened regularly for conditions that may contribute to heart disease, such as high blood pressure and high cholesterol.


Management of Diabetes:

1. Home treatment: Diabetes can be controlled by a healthy lifestyle, choices of diet, exercise, and other healthy habits at home.

2. Diet: A healthy diet is important in controlling blood sugar levels and preventing diabetes complications. If the patient is obese he can adopt a weight modification program to help reduce his body weight. Eating a consistent, well-balanced high fiber diet, low in saturated fat, and low in concentrated sweets improves the health.

3. Exercise: Regular exercises can help to reduce the risk of developing diabetes. Activity can also reduce the risk of developing complications of diabetes such as heart disease, stroke, kidney failure, blindness, and leg ulcers. As little as 20 minutes of walking three times a week has a proven beneficial effect.
4. Alcohol use and smoking: Use moderate alcohol or eliminate consumption of alcohol altogether. Smoking cigarettes raises the risk markedly for nearly all of the complications of diabetes. Smoking damages blood vessels and contributes to heart disease, stroke, and poor circulation in the limbs.
5. Self-monitored blood glucose: Check blood sugar levels frequently, at least before meals and at bedtime, and record the results in a logbook. This logbook should include insulin or oral medication doses and times, the time and what the patient ate, when and for how long they exercised, and any significant events of the day such as high or low blood sugar levels etc.

6. Medical Management: The treatment of diabetes is individualized depending on the type of diabetes, whether the patient has other active medical problems, whether the patient has complications of diabetes, and age and general health of the patient at the time of diagnosis. Education about diabetes and its treatment is essential in all types of diabetes.

Treatment of Type 1 diabetes:

Treatment of diabetes always involves the daily injection of insulin, usually a combination of a short-acting insulin and a longer acting insulin. Insulin must be given as an injection. When taken by mouth, insulin would be destroyed in the stomach before it could get into the blood stream so it has to be given as an injection. Most people with type 1 diabetes take insulin injections by themselves as it is important that the patient knows how to do it in case the other person is unavailable. Insulin is usually given in two or three injections per day, generally around mealtimes. Dosage is individualized and is tailored to the patient's specific needs by the healthcare provider. Longer acting insulins are typically administered one or two times per day. It is essential that the patient have adequate meals if the insulin is to be administered, as the insulin will lower the blood sugar regardless of whether they have taken meals. If insulin is taken without eating, the result will be hypoglycemia which called an insulin reaction. Maintaining accurate records of blood sugar levels and insulin dosages is very important for the patient's diabetes management. Eating a consistent, healthy diet appropriate for the patient's size and weight is essential in controlling blood sugar level.

Insulins: Human insulin is the only type of insulin that is less likely to cause allergic reactions than animal-derived varieties of insulin. The type of insulin chosen to customize treatment for an individual is based on the goal of providing optimal blood sugar control. Different types of insulin are available and categorized according to their times of action, onset, and duration. Commercially prepared mixtures of some insulins may also be used to provide constant (basal) control and immediate control. According to the duration of action there are rapid-acting insulins, intermediate-acting insulins, and long-acting insulins.

Treatment of Type 2 diabetes:

Depending on how elevated the patient's blood sugar and glycosylated hemoglobin (HbA1c) are at the time of diagnosis, they may be given a chance to lower blood sugar level without medication. The best way to do this is to lose weight if obese and start an exercise program. This will generally be tried for three to six months, then blood sugar and glycosylated hemoglobin will be rechecked. If they remain high, the patient will be started on an oral medication, usually a sulfonylurea or biguanide to help control blood sugar level. It is still important to eat a healthy diet, lose weight if they are overweight, and engage in moderate physical activity as often as possible. It is important to get just the right dose of the right medication to get the blood sugar level in the recommended range with the fewest side effects. The doctor may decide to combine two types of medications to get blood sugar level under control. Even people with type 2 diabetes may require insulin injections to control their blood sugar levels.


Many different types of medications are available to help lower blood sugar levels in type 2 diabetes. Each type works in a different way. It is very common to combine two or more types to get the best effect with fewer side effects.
1. Sulfonylureas: These drugs stimulate the pancreas to make more insulin.
2. Biguanides: These agents decrease the amount of glucose produced by the liver.
3. Alpha-glucosidase inhibitors: These agents slow absorption of the starches one eats. This slows down glucose production.
4. Thiazolidinediones: These agents increase sensitivity to insulin.
5. Meglitinides: These agents stimulate the pancreas to make more insulin.
6. D-phenylalanine derivatives: These agents stimulate the pancreas to produce more insulin more quickly.


Follow up Treatment:

Follow the healthcare provider's treatment recommendations. Keep records of blood sugar levels as often as recommended by the healthcare provider, including the times the levels were checked, when and how much insulin or medication was taken, when and what was eaten, and when and for how long the patient exercised. Call the healthcare provider if in any emergency.


Education:

Attend diabetes education classes at the local hospital. The more educated the patient and their family are about the disease, the better they are likely to do. Recognize low blood sugar levels and know how to treat them. The patient and their family should be taught how to recognize the signs and symptoms of low blood sugar levels.

It is of importance that early detection and treatment of diabetes is essential in treating this disease effectively and reducing its complications. So hope this article will help you in detecting diabetes early in its course and help prevent its prevalence.




 

Characteristics of Inflammation

Characteristics of inflammation

We all have inflammation in our body at one point or the other caused during activities, physical stress, accidents, animal or insect bites, pathogenic organisms etc. Inflammation can occur on the skin and subcutaneous tissue, respiratory tract, urinary tract, gastrointestinal tract etc. Usually we find swelling, pain, redness, or infection in that area. What is inflammation and what all happens when our body has an inflammation and what are the clinical features of inflammation?

When an area of the body is injured or altered from its normal structure, it is invaded by bacteria, virus, or parasite etc. and the body produces a defense mechanism by which the harmful antigens are destroyed or removed. A series of actions occur which protects our body from the harmful agent and all these constitute an inflammation or inflammatory reaction. These are detected by its clinical features, which are the 5 signs of inflammation.

Cardinal signs of inflammation:

1. Rubor (redness)
2. Calor (heat)
3. Dolor (pain)
4. Tumor (swelling)
5. functio laesa (loss of function).

The area becomes hot, red, and painful. There will be swelling all over the area and subsequently loss of function of the body part. The redness and heat are due to the increased blood flow to the inflamed site, swelling is caused due to accumulation of fluid and pain is due to the release of chemicals that stimulate the nerve endings.


Process of inflammation: The inflammatory process is initiated by cells present in the tissues such as resident macrophages, dentritic cells, histiocytes, Kuppfer cells and mastocytes. When a burn, injury, or infection occurs these cells undergo activation and release inflammatory mediators responsible for the clinical signs of inflammation mentioned above. Inflammation is characterized by marked vasodilation, increased permeability, and slowing of blood flow. Vasodilation or the dilation of the blood vessels in the affected area produce a net increase in the blood flow to that area causing redness (rubor) and heat (calor). The increased permeability of the blood vessels results in exudation or leakage of the of plasma proteins and fluid into the tissue which manifests as the swelling (tumor). The mediators that are released such as histamine and bradykinin increases the sensitivity to pain and cause pain(dolor). Increased permeability of the blood vessel results in movement of plasma proteins and fluid into the tissues with resultant stasis of blood due to increased concentration of cells in the blood, a condition characterized by engorged blood vessels filled with blood cells. Stasis or slowing of the blood occurs and results in migration of the white blood cells or leukocytes which is mainly neutrophils that move towards the walls of the blood vessel into the tissues called margination. The neutrophils migrate along a chemotactic gradient created by the local cells to reach the site of injury. The loss of function (functio laesa) is the result of a neurological reflex in response to pain.

Neutrophil margination during inflammation

Cellular changes: The main cellular component that takes part in inflammation are the leukocytes or the white blood cells. These cells move from the blood into the inflamed tissue by extravasation to assist inflammatory process. Some act as phagocytes ingesting bacteria, virus, and cellular debris etc. Others release enzymatic granules which damage the pathogenic invaders and releases substances which mediate and develop the inflammatory response. When the bacteria have invaded the inflamed area, the emigrated leukocytes are attracted to the bacteria in the infected tissues by a process called chemotaxis.The leukocytes which include neutrophils, eosinophils, and monocytes, phagocytose (swallow) the bacteria and digest them. So bacteria and other foreign bodies are digested and destroyed from the site of inflammation. Some leucocytes die along with other degenerated tissue and dead bacteria is turned into a white liquified form called the pus.


Mediators of inflammation: There are a number of cellular and plasma based mediators which helps in modifying the inflammatory process

1) The cell based (RBC, WBC, platelets) mediators are lysosome granules, histamine, IFN-y, IL-8, leucotriene B4, nitrous oxide, prostaglandins, TNF-alfa, and IL-1.
Lysosome granules are present in granulocytes. These cells contain a large number of enzymes which perform certain functions to facilitate inflammation.
Histamines are vasoactive amines present in mast cells, basophils, and platelets. Histamine causes areteriolar dilation and increased venous permeability.
Interferons are found in T-cells and NK cells. They have antiviral, immunoregulatory, and anti-tumour properties.
Interleukins are found primarily in macrophages. It helps in activation and chemoattraction of neutrophils, monocytes, and eosinophils.
Leukotrienes are found in leukocytes. It is ble to mediate leukocyte adhesion and activation, allowing them to bind to the endothelium and migrate across it.
Nitric oxide is found in macrophages and endothelial cells. It is a potent vasodilator. It relaxes smooth muscle, reduces platelet aggregation, aids in leukocyte recruitment, and antimicrobial activity in high concentrations.
Prostaglandins are found in mast cells. These are a group of lipids which can cause vasodilation, fever, and pain.

 
2) The plasma based (fluid in the blood)  mediators include bradykinin, plasmin, thrombin, C3, C5a, Factor XII etc.
Bradykinin is produced by the kinin sytem. It is a vasoactive protein which is able to induce vasodilation, increase vascular permeability, cause smooth muscle contraction, and induce pain.
C3 is produced by the complement system. It cleaves to produce C3a and C3b. C3a stimulates histamine release by mast cells and thereby producing vasodilation. C3b  binds to bacterial cell wall and act as an opsonin, which marks the invader as a target for phagocytosis.
C3a is produced by the complement system. It stimulates histamine release by mast cells, thus producing vasodilation. It also act as a chemoattractant to direct cells by chemotaxis to the site of inflammation.
Factor XII is produced in the liver. It is a protein which circulates inactively in the blood plasma, until activated by collagen, platelets, or exposed basement membranes. When activated, it is able to activate three plasma systems involved in inflammation: the kinin system, fibrinolysis system, and coagulation system.
Plasmin is produced by the fibrinolysis system. It is able to break down fibrin clots, cleave complement protein C3, and activate Factor XII.
Thrombin is produced by the coagulation system. It cleaves the soluble plasma protein fibrinogen to produce insoluble fibrin, which aggregates to form a blood clot.

An acute inflammation usually resolve with resolution of symptoms and relief of associated infection if proper measures are undertaken. It can also go into a severe or more chronic phase when those underlying causes are not controlled or eliminated.


These are some of the processes that happen when an acute inflammation occurs in the part of our body. Hope you get an idea about what actually inflammation is, what the signs of inflammations are, what processes that happen in an acute inflammation at the cellular level and about the mediators of inflammation.






 

Compatibility In Human Blood Groups

We come across circumstances where there is a need to transfuse blood in conditions of medical emergency or undergoing surgeries when patient will require blood transfusion. Good precautions are taken in testing the blood between the donor and the recipient. When blood from one person is transfused to another person, it must be ensured that donor's blood perfectly matches with the blood of the recipient, otherwise mismatch between these blood groups occur. If a unit of incompatible blood is transfused between the a donor and a recipient it results in serious reaction, like an acute hemolytic reaction which occurs with hemolysis of RBC, renal failure, and shock leading the death of the individual. Whereas Rh incompatibility in pregnancy is a hazard while delivering a child.

The blood group or blood type is a classification of the blood based on the presence or absence of inherited antigenic substances on the surface of red blood cells (RBCs). These antigens may be proteins, carbohydrates, glycoproteins, or glucolipids depending on the blood group system.


The RBC cell membrane contains 2 main classes of antigens, namely 1) ABO and 2) Rh system.
1) The ABO system is the most important blood group system. The cell membrane of RBC contains antigen called agglutinogens. There are 2 such agglutinogens, A and B and so blood in human beings can be classified into 4 groups based on this.

i. Persons whose RBC membrane contains A agglutinogen in their blood can be categorized as group A.
ii. Similarly persons whose RBC membrane contains B agglutinogen in their blood can be called group B.
iii. Some persons have both A and B agglutinogens in their blood and therefore called AB group.
iv. Some persons have no agglutinogen in their RBC membrane and so is named as O blood group.

The plasma (fluid) in the blood also contains agglutinins which are antibodies present in the blood. There are 2 main classes of antibodies in the blood called 1) anti A antibody or alpha antibody, and 2) anti B antibody or beta antibody. Based on the agglutinins present in the human plasma the blood can be classified into 4 groups.

i. Persons whose blood plasma contains anti A antibody or alpha antibody.
i. Persons whose blood plasma contains anti B antibody or beta antibody.
iii. Persons whose blood plasma contains both anti A antibody and anti B antibody.
iv. Persons whose blood plasma contains no antibodies.

Blood Groups:

When group A blood is admised with the serum or plasma containing A agglutinin and the RBC containing A agglutinogen, the anti A agglutinin attacks the A agglutinogen and the blood gets agglutinated or the RBCs are clumped together. The clumped RBCs can cause 1) blocking the circulation in a small blood vessel or arteriole producing disaster and 2) undergo hemolysis and produce hazards including free Hb blocking renal tubules causing jaundice.

A person whose blood group is A, cannot have anti A agglutinin in his or her blood. Also in a person with B group, there can be no anti B agglutinin in his or her blood. Likewise in a person whose blood group is AB group there cannot be any agglutinin either A or B present in his or her plasma, and in a person whose blood group is O group there will be both A and B agglutinin present in his or her plasma.

For example, group A blood is transfused in a person belonging to group B,

Donor's blood contains A agglutinogen in the RBC and beta agglutinin in the plasma, while the recipeint's blood contains B agglutinogen in the RBC and alpha agglutinin in the plasma. The donor's RBC will be clumped and lysed by the recipient's alpha agglutinin. However the beta agglutinin of the donor will be so much diluted in the recipients blood that it will cause no harm of the recipient's RBCs.

So in a mismatched blood transfusion, donor's RBCs are lysed but the recipients RBCs remain unharmed.
O group of blood can be transfused (donated) to all groups of the ABO system, so it is called as the universal donor. AB  group of blood is called the universal recipient because any of the blood groups can be safely transfused (received) in the AB group person All these groupings are safe provided there is no Rh incompatibility.

a) Individuals with type A blood can receive blood from donors of type A and type O blood.
b) Individuals with type B blood can receive blood from donors of type B and type O blood.
c) Individuals with type AB blood can receive blood from donors of type A, type B, type AB, or type O blood. Type AB blood is called the universal recipient.
d) Individuals with type O blood can receive blood from donors of only type O.
e) Individuals of type A, B, AB and O blood can receive blood from donors of type O blood. Type O blood is called the universal donor.

RBC Compatibility Diagram

Plasma Compatibility Diagram

2) Rh System:

Rh owes the name to the rhesus monkey in whom this group was first discovered. There are several Rh groups but only factor D is clinically important. When Rh D is present in the RBC, the person is said to be
Rh +ve and when Rh is absent in the RBC, the person is Rh -ve. About 90% of the population is Rh +ve and about 10% is Rh -ve. Rh -ve persons provided they have not received an Rh +ve blood group have no Rh antibodies.

In ABO system agglutinins or antibodies occur naturally, that is without being exposed to the corresponding antigen. In Rh system, Rh antibodies are not naturally occurring and it appears only when Rh +ve RBC's enter in a Rh -ve person's blood. The exposure clinically occurs under 2 instances, i) when a Rh -ve person recieves Rh +ve blood through transfusion and ii) when Rh -ve mother conceives a Rh +ve fetus.
An Rh D-negative patient who does not have any anti-D antibodies (never being previously sensitized to D-positive RBCs) can receive a transfusion of D-positive blood once, but this would cause sensitization to the D antigen, and a female patient would become at risk for hemolytic disease of the newborn. If a D-negative patient has developed anti-D antibodies, a subsequent exposure to D-positive blood would lead to a potentially dangerous transfusion reaction. Rh D-positive blood should never be given to D-negative women of child bearing age or to patients with D antibodies.

There are the main blood groupings which we have to consider when doing a blood transfusion. Hope you will keep these in mind when you come across blood any transfusion procedure in the future.