Vegetarianism and Balanced Diet

There are some concerns as to how to obtain a wholesome diet if someone is a vegetarian.
I will consider a few points here.
1. Proteins from animal sources (meat, chicken) have a high biological value (B V). The proteins in cereals and legumes have a lower BV. For those vegetarians,who are not averse to eating eggs, this fact is compensated to some extent. Soybeans has the highest percentage of proteins amongst all cereals and legumes, thus more consumption is indicated.

2. Vitamin B12 comes from animal sources (meat). It is not found in vegetable sources. While milk and milk products do provide B12, for vegans (who consider even milk out because it comes from animals) this source is also out. The answer is fortified foods, like cereals which will give you B12.

3. Fish is considered nutritious because it provides rich amounts of proteins and omega-3 fatty acids. For the vegetarians, walnuts (akhrot) and vegetable oils like canola oils will give you omega -3.

4. One aspect about milk is worth mentioning. Although milk is a considered a wholesome item, it is not a good source of iron.

Eagle Barrett Syndrome

1. Prune Belly syndrome is also called Eagle Barrett Syndrome. Main features: hypoplasia of abdominal musculature, cryptorchidism.

2. HIDA Scan:

A HIDA scan is an imaging test used to examine the gallbladder and the ducts leading into and out of the gallbladder. In this test, also referred to as cholescintigraphy, the patient receives an intravenous injection of a radioactive material called hydroxy iminodiacetic acid (HIDA). The HIDA material is taken up by the liver and excreted into the biliary tract. In a healthy person, HIDA will pass through the bile ducts and into the cystic duct to enter the gallbladder. It will also pass into the common bile duct and enter the small intestine, from which it eventually makes its way out of the body in the stool.
HIDA imaging is done by a nuclear scanner, which takes pictures of the patient's biliary tract over the course of about two hours. The images are then examined by a radiologist, who interprets the results. It is generally a very safe test and is well tolerated by most patients.

Indications of GH

Indications for GH therapy:

A] GH- deficiency

B] Non- GH-deficient conditions:
1. SGA (small for gestational age)
2. Ch renal failure
3. Turner syndrome, Prader- Willi
4. Idiopathic short stature: most controversial

Side effects of GH:
1. Pseudo-tumor cerebri
2. arthralgia, myalgia
3. rash
4. Hypothyroidism
5. SCFE (slipped capital femoral epiphysis)

GH deficiency in neonatal period

The two pointers towards possible growth hormone (GH) deficiency in neonatal period are:
1. Hypoglycemia: in persistent hypoglycemia, GH deficiency should be ruled out.
2. Micro-phallus: always do accu-checks and this can lead to further investigations.

Congenital Amputation

Yesterday in the clinic, I saw a one year boy-on a follow up visit- who was born with Congenital Below Elbow Amputation (BEA). It was an isolated abnormality and genetic consult revealed no syndromic association.

OSD

Osgood-Schlatter disease (OSD) is one of the most common causes of knee pain in the adolescent. In the US, exact incidence is not known, but it is quite common.
Consisting of pain and edema of the tibial tubercle (and hence this is an extra-articular disease), OS disease is generally a benign, self-limited knee condition associated with 'traction apophysitis' in adolescent boys and girls.

Save your heart

Despite hygienic food, regular exercizes one will not know as to whether his heart is developing coronary artery disease or not. No more! You can get the status of your coronaries to assess whether they are developing plaques (which lead to narrowing and hence ischemic heart disease). Dr Sanjay Gupta in the Time magazine (January 22, 2007) suggests that use of CT Angiography (a kind of CAT scan)- which is non invasive- will tell you of any developing plaque. Thus before you attain the age of 40, get one such scan and then at least you know the exact status of your heart. And the old mantra of being a vegetarian is now fast catching up. Be vegetarian and be more healthy!

The link to this article: http://www.time.com/time/magazine/article/0,9171,1576846,00.html

Angelman Syndrome

Today we counselled a mother at a Manhasset facility (New York) whose 18 months female kid's chromosomal studies have confirmed Angelman Syndrome (happy puppet syndrome, thus use of this term is not encouraged now). Her face was not really dysmorphic, though striking features are: maxillary hypoplasia, deep set eyes, wide mouth with prognathism.

Initailly described by Dr Harry Angelman in 1965, this is a syndrome with deletion defect (15 p- and this is maternally contributed. Paternal contribution results in Prader Willi syndrome).

Other features:
Developmental delay, particularly speech (none or minimal words), movements: ataxia or tremulous gait.
Seizures with high probability around 4 years of age, resolve by 10 years.
Sleep disturbances, strabismus.

For more details about this syndrome, log onto: www.angelman.org

Infant Mortality Rate (IMR)

Infant Mortality Rate (IMR) denotes number of kids dying in first year of their lives per 1000 alive kids in a year. In USA, the IMR is roughly 7/1000 kids, whereas it was 3.1 in HongKong in 1999. In January,07 The Tribune (published from Chandihgarh, India) reports that IMR has come down to 42/1000 alive kids in the state of Haryana.