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This petite whole Methyl mercury concerns from eating fish grain has a mild flavor and can be eaten whole or ground diabetes medications in renal insufficiency cheap 5 mg glyburide otc, raw or cooked diabetes mellitus basics ppt buy 2.5 mg glyburide mastercard. Chia seeds can be soaked in Limit eating large fish due to diabetes mellitus may be caused by a deficiency in this hormone generic 5 mg glyburide greater mercury water and added to diabetes mellitus with hypoglycemic coma code generic glyburide 5mg mastercard salads, dhal or chapatti flour. Traditionally chia seeds are used in Indian desserts that are high in saturated fat and – King mackerel calories. A high salt intake also has effects causing cholesterol when used in place of saturated fat. Be aware of how much salt is added to food during preparation and Corn oil, safflower oil, sunflower oil also read labels of ready-prepared foods. In Sunflower seeds addition to a low salt diet a blood pressure lowering diet should also be low in saturated fat and high in 2. Saturated fatsSaturated fatsSaturated fatsSaturated fats vegetables, fruits and non-fat dairy products. Six strategies for a heart healthy diet for Asian Sources of saturated fat are: Indians Fatty cuts of lamb, pork, beef, poultry with skin, the following six strategies are practical tips geared beef fat, lard, bacon, sausage, hotdogs towards the Asian Indian cuisine. For regional Whole milk & whole milk dairy products: cuisines, refer to the variety of regional cuisines in butter, cheese, cream, ice-cream, yogurt made this book. Palm oil, palm kernel oil and coconut oils Strategy # 1 Protein Foods: 2 tStrategy # 1 Protein Foods: 2 to 3 Servings DailyStrategy # 1 Protein Foods: 2 tStrategy # 1 Protein Foods: 2 to 3 Servings Dailyo 3 Servings Dailyo 3 Servings Daily 3. Trans-fats are primarily (chicken & turkey) or 4 oz tofu or one egg plus man-made from vegetable oils as a result of food two egg whites combined. Trans-fats are include beans, lentils, seafood, poultry, lean also found naturally in meat, cheese, butter and meat and egg whites. Baked goods: pastries, cakes, donuts, cookies Eat fish twice at least per week if religion Fried foods: French fries, fried chicken, onion permits. Increase the amount and variety of rings, Indian savory snacks cooked in re-used fish and seafood consumed by choosing oil. Strategy # 3: Vegetables & Fruits 8 ServingsStrategy # 3: Vegetables & Fruits 8 ServingsStrategy # 3: Vegetables & Fruits 8 ServingsStrategy # 3: Vegetables & Fruits 8 Servings salmon, pollock, catfish, cod, clams, flounder, (4. Eat a variety of vegetables, especially dark-green and red and One egg three times per week is quite orange vegetables and beans and peas. Consume leafy green vegetables eyed beans) prepared with only a small amount (spinach, cabbage, kale, mustard greens) & of oil are an excellent source of protein and cruciferous vegetables (cauliflower, brussel soluble fiber. Legumes (dried beans and Strategy # 4:Strategy # 4: Whole Grains: 6 Servings DailyStrategy # 4: Whole Grains: 6 Servings DailyStrategy # 4: Whole Grains: 6 Servings DailyWhole Grains: 6 Servings Daily lentils) including “daal” are naturally low in fat, high in protein and carbohydrate, plant sterols Consume at least half of all grains as whole and fiber. Reduce the Vegetarian burger patties can be convenient and amount of rice/chappatis when potatoes or nutritious alternative to the meat patties. Check other starchy vegetables are also included in the the total fat, saturated fat and cholesterol same meal. Add Strategy # 2 Dairy Products 2 to 3 Servings DailyStrategy # 2 Dairy Products 2 to 3 Servings DailyStrategy # 2 Dairy Products 2 to 3 Servings DailyStrategy # 2 Dairy Products 2 to 3 Servings Daily oatmeal (high in soluble fiber) &/or soy flour (high in protein) to chapatti flour. To control One serving includes 1 cup = 8oz non-fat milk calories, avoid putting ghee/oil when making or 1% milk or low fat buttermilk or non-fat chappatis. Substitute other whole grains for rice & pulao Increase intake of fat-free or low-fat milk and. Bennecol spread Strategy # 5: Fats & Oils 4Strategy # 5: Fats & OilsStrategy # 5: Fats & OilsStrategy # 5: Fats & Oils 44-4-6 tsp Daily-6 tsp Daily6 tsp Daily6 tsp Daily and Promise Activ spread. Prepare foods using lower fat cooking methods Beverage supplements containing plant sterols such as grilling, broiling and baking instead of such as Cholest-off and Minute Maid Heart frying and sauteing. Plant sterols in food or Avoid ghee, butter, whole milk & cream in food supplements should be consumed with meals preparation & processed foods to reduce because they help to lower the absorption of saturated fat intake. Higher cream are high in saturated fat, coconut water doses above 2 g/day offer little additional (nariyalpaani) is not high in saturated fat. Since plant sterol/stanol fortified use of whole milk in Indian tea “chai” because spreads and supplements also provide calories, it adds saturated fat in the diet. These are generally prepared with they are high in calories and may lead to weight saturated fat. Re-use of unsalted nuts per week is associated with a cooking oils increases the trans-fat content of reduced risk of heart disease. Trans-fats are found in Indian In Indian restaurants select appetizers and savory/snack foods. These are made with appetizers are tandoori fish, tandoori saturated fat and trans-fat. Select a heart healthy spread (free of saturated Avoid entrees prepared with added cream or and transfat) instead of butter or ghee, Read butter or fried foods. Then Sodium Daily to Lower Blood PressureSodium Daily to Lower Blood PressureSodium Daily to Lower Blood PressureSodium Daily to Lower Blood Pressure look for as little saturated fat as possible. Look for spreads with less than a total of 2 grams the American Heart Association and the from saturated and trans-fat per serving. Choose foods with dietitian in private practice in Irvine, California anddietitian in private pracdietitian in private pracdietitian in private practice in Irvine, California andtice in Irvine, California andtice in Irvine, California and lower numbers. To Other Non communicable DiseasesfiNew reduce salt in the recipe, enhance flavor by World Bank Report. An epidemic of risk factors for cardiovascular If you drink and if your physician approves because disease the Lancet, Volume 377, Issue 9765, you have no medical reasons not to drink alcohol, Page 527, February 12, 2011. The Importance of Population-Wide Sodium E and/or beta carotene have not shown any benefit Reduction as a Means to Prevent in the prevention of heart disease. Some studies Cardiovascular Disease and Stroke: A Call to have shown they could be harmful. The Practical Guide: Identification, Evaluation A registered dietitian has expertise in nutrition. Van Horn L, McCoin M, Kris Etherton P M, Definition of the Metabolic Syndrome, Report Burke F, Carson J, Champagne C, Karmally W, of the National Heart, Lung, and Blood Sikand G. Dyslipidemia among Indo-Asians: Md: Agency for Healthcare Research and Strategies for identification and management. Preventive descent: the National Asian Indian Heart Cardiology, McGraw Hill 1999; 13: 319-72. Comparison Therapy Delivered by Registered Dietitians for of large and small High density lipoprotein Disorders of Lipid Metabolism: A Call for cholesterol in Asian Indian men compared to Further Research. Coronary heart disease in Asian Statement from the American Heart Associaton Indians. Reduction in obesity, and physical activity to plasma Weight and Cardiovascular Disease Risk lipoprotein levels in Asian Indian physicians Factors in Individuals with Type 2 Diabetes. Barnett and Garg, Preventing cardiovascular dyslipidemia, and the metabolic syndrome. What you need to know about mercury in fish Nutrition Therapy lowers serum cholesterol and shellfish. It 1 medium egg or fi cup egg substitute is necessary for growth and repair of body tissues. Canned or packaged soup Fast foods Always remember to take your phosphorus binders Pot pies with a meal or snack. These protein foods are high in Potassium andThese pThese pThese protein foods are high in Potassium androtein foods are high in Potassium androtein foods are high in Potassium and Phosphorus. Check with your Dietitian before Portion Guide for Protein FoodsPortion Guide for Protein FoodsPortion Guide for Protein FoodsPortion Guide for Protein Foods usingusingusingusing Half chicken breast is about 3 to 4 ozs. Can I be a vegetarian if I have chronic kidneyCan I be a vegetarian if I have chrCan I be a vegetarian if I have chrCan I be a vegetarian if I have chronic kidneyonic kidneyonic kidney Dialysis and Protein FoodsDialysis and Protein FoodsDialysis and Protein FoodsDialysis and Protein Foods diseasefi You should protein, the amount of Albumin in your blood will talk with a renal dietitian about foods that are be measured monthly. Studies have some things your dietitian may implement for your shown that people on dialysis who have an albumin new diet: of 4. Monitor your calorie intake to make sure you these protein-These proteinThese protein-These protein-rich foods are high in sodium and-rich foods are high in sodium andrich foods are high in sodium andrich foods are high in sodium and are getting enough calories. Processed MeatsProcessed MeatsProcessed MeatsProcessed Meats Increase your phosphate binders that may be Lunch meats needed for meals and snacks. Pickled fish Lower potassium dialysate for those on dialysis Sardines/canned fish to control potassium levels.

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Metastatic nodes are usually hard but metastatic melanoma and lymphoma nodes are soft diabetes in dogs alternative treatments cheap glyburide 5 mg with mastercard. In these cases diabetic diet recipes glyburide 5 mg fast delivery, neck movements (fexion blood glucose 500 buy glyburide 5mg on line, extension ga1 metabolic disorder generic glyburide 2.5mg free shipping, rotation and lateral fexion) are limited. DiagNoStic teStS fi Fine needle aspiration cytology and open biopsy: A 25-gauge In suspected cases of infammatory adenopathy, a trial of antibineedle biopsy is gold standard in diagnosis of a neck mass. It is helpful in thyroid disorders, and in localizing the mass inside or infection outside of the salivary gland. Other features are cardiac arrhythmias, congestive cardiac failure and swelling of ankles. Sea fi Age and sex: Thyroid swellings (goiter) are more common in fsh has low iodine contents. Papillary carcinoma is common in Look for the features of hyperthyroidism such as exophthalmos young girls whereas follicular carcinoma occurs in middle(staring), excitability, trembling, nervousness, sweating and aged women. Thyrotoxicosis may appear in women fi Abdominal examination: In women with Hashimoto’s having stress and strain. Sudden increase in the size of disease, liver and spleen should be examined for cirrhosis. Simple goiters grow very slowly, and may remain of the same size for years at local examination a stretch. The papillary and follicular carcinomas Inspection (Figs 9 and 10) and palpation of goiter are similar to examination of the swelling (See Chapter: History and also grow slowly for years before metastasizing. Anaplastic Examination) and neck, and include site, shape, size, extent, carcinoma grows fast. In this disease, the brunt of attack falls cases of chronic thyroiditis infammation and malignancy. Note the obliteration of method reveals the thyroid swelling better suprasternal space that raises suspicion of retrosternal extension Fig. Patient is frst requested to swallow her saliva and neck fexed then surgeon pushes his fngers in suprasternal region to feel the lower extent of thyroid mass cases, it is not possible to get the lower limit of goiter on deglutition. Raising of both arms and touching both the ears result into facial congestion, cyanosis and distress. Clinically, it is difcult to know whether the nodule is solid or cystic because the cystic fuid may be under great tension. Ultrasonography neck examination easily diferentiates between solid and cystic swellings. Malignant goiter can engulf the carotid sheath and then carotid pulsations are not detected. Cervical sympathetic trunk: Its involvement gives rise to Horner’s syndrome, and suggests malignancy. In advanced cases, whole fi Measurement of neck circumference: Measurement of neck body may shake and tremble. It is better present on fi Metastasis: In addition to the draining neck lymph nodes, the upper pole. The brunt of disease falls on cardioFree T and T: T and T are bound to serum proteins. The small amount biologically active hormones remain Atrial fbrillation and heart failure may supervene later on. The following signs should be looked for: Von Graefe’s sign: the upper eyelid lags behind when patient looks downward. Joffroy’s sign: There is no forehead wrinkling when patient looks towards ceiling keeping the head downward. In the follow-up cases of thyroid carcinomas, surgeon should not forget that anti-thyroglobulin antibody afects the levels of thyroglobulin levels. Their indications include malignancy, Levels of T, T and thyroid stimulating retrosternal extension and recurrent thyroid swellings. Whole-body scanning is indicated in Euthyroid Normal Normal Normal operated patients of thyroid carcinoma to demonstrate metastases. Technetium (99mTc) is cheaper than radiolaThyrotoxicosis High High Low/ Undetectable 123 belled iodine (I). Isolated cysticercosis cellulosae of sternocleidomastoid muscle: a case report with review of literature. Neck Nodes, Masses and Thyroid 53 If you project hatred and jealousy, they will rebound on you with compound interest. No power can avert them; when once you have put them in motion, you will have to bear them. See the table of common neck masses in Chapter developmental, infammatory and neoplastic neck masses. In contrast, (Unknown primary lesions) neoplasia should be considered frst in older adults. The specifc history aspects and physical findings limit the number of Any unknown asymptomatic asymmetric neck mass in the diagnostic tests, and can avoid unnecessary investigations. Histopathology: It is helpful in diferentiating lymphoma – Postoperative radiotherapy: Though still controverfrom carcinoma. It is used to measure cell Disadvantages: size, number, viability and nucleic acid content. Positron emission tomography scanClosure: In cases of supraclavicular adenocarcinoma ning is controversial in detecting unknown primary for head and lymphoma, staging before radiation and/or chemoand neck tumors. An obvious lesion must be biopmetastatic neck nodes when the primary lesion is not found sied. If no obvious lesion is found then depending upon upon physical examination including fexible/rigid endoscopy, the region of lymph nodes involved, deep submucosal biopsies from four silent primary sites should be taken. These biopsies should be performed from the following silent four silent sites are nasopharynx, tongue base valleculae, primary tumor sites: pyriform sinus and tonsils (tonsillectomy). Nodes high in the neck or posterior triangle: Fossa of Rosenmuller in nasopharynx. Thyroid Neoplasms Jugulodigastric nodes: – Tonsil: Tonsillectomy is done as the tumor arises these constitute a leading cause of anterior-compartment neck deep in the crypts of tonsil (Fig. Usually, have a greater incidence of benign lesions with a female there are no other local head and neck symptoms. Recurrence needs if any, is necessary for staging at the time of neck node surgery. Evaluation of gastrointestinal or central nervous system is – Functioning nodules are managed by suppression. Approximately 25% of solitary cold nodules fi Clinical features: Enlarging solid mass lies in front of and are found cystic and another 25% prove to be below the ear, at the angle of mandible (parotid) or in the cancerous. Malignant tumors present with pain, rapid growth, facial nerve palsy (parotid) or skin fxation. They are not order) are mouth/oropharynx, trachea/bronchus/lungs, preferred by many surgeons. In fi Open biopsy (superficial parotidectomy or complete women, these are (in descending order) breast, cervix, ovary, submandibular gland removal): this is the procedure of mouth/oropharynx, esophagus and lymphomas/multiple preference. Nature: Pulsatile and compressible, which often rapidly Eighty percent children with Hodgkin’s disease have at refll on release of pressure. Radiotherapy is preferred in elderly patients or extensive tumors in high-risk patients. Schwannomas or Neurilemmomas fi Clinical features: these neurogenic tumors are solid. They usually persist as soft, doughy, variably-sized masses even after the course of antibiotics. Their remnant tract may course between carotid branches anterior to glossopharyngeal and hypoglossal nerves, and enter into oropharynx. Soft and doughy swelling in the midFirst branchial cleft cyst (less common): Along the infeline of anterior neck in a child rior border of mandible, at the angle of mandible or just below the ear lobule. The tract ascends just deep-to-deep cervical cervical lymphangioma (cystic hygroma) fascia along the carotid artery. This cavernous lymphangioma is said to be the result of fi Course of tracts: They are: incomplete development and obstruction of normal lymphatic Second branchial cleft sinus: the tract passes between system.

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The differential diagnosis includes stomatitis medicamentosa diabetes type 1 tattoo designs generic 2.5mg glyburide with mastercard, erythema multiforme diabetes type 2 excessive sweating order 2.5mg glyburide overnight delivery, pemphithe differential diagnosis includes erythema mulgus vulgaris diabetic diet kits discount glyburide 5mg free shipping, cicatricial pemphigoid blood sugar parameters cheap 5mg glyburide mastercard, bullous pemtiforme, pemphigus, bullous pemphigoid, cicatriphigoid, and erosive lichen planus. Antibiotic-induced Stomatitis Systemic long-term administration of broad-spectrum antibiotics, such as tetracycline, may cause a form of stomatitis. Clinically, it is characterized by a nonspecific diffuse erythema of the oral mucosa. The tongue is extremely red and painful, with desquamation of the filiform papillae (Fig. Hairy tongue and candidosis may also occur as a result of changes in the oral microbial flora. The differential diagnosis includes stomatitis medicamentosa, erythema multiforme, pellagra, and ariboflavinosis. Antibiotic-induced stomatitis, diffuse erythema and desquamation of the filiform papillae of the tongue. Oral Lesions due to Drugs Ulcerations due to Methotrexate Pen icillamine-induced Oral Lesions Methotrexate is a folic acid antimetabolite that is D-penicillamine, a heavy metal chelator used in used in the treatment of leukemias, solid cancers, the treatment of hepatolenticular degeneration psoriasis, etc. The most common side effects are cystinuria, and heavy metal intoxication), may be alopecia, liver and gastrointestinal disorders, etc. The noncutaneous side effects include terized by redness and painful erosions or ulcers hematologic, pulmonary, gastrointestinal, renal, (Fig. The most lips, and buccal mucosa, although they may occur common cutaneous manifestations are autoimanywhere in the oral cavity. The most common oral manifestation is penicillamine-induced pemphigus, which is the differential diagnosis includes traumatic characterized by vesiculobullous lesions and eroulcer, thermal and chemical burn, and stomatitis sions of the oral mucosa, clinically, histopathologmedicamentosa. Penicillamine-induced pemphigus usually appears Ulceration due to Azathioprine within 6 to 12 months after initiation of the drug and may resolve within several weeks after withAzathioprine is an antimetabolite widely used as drawal of the drug. Alopecia, gastroinaphthous stomatitis, and taste loss are also oral testinal disorders, and bone marrow toxicity are complications of the drug. Rarely, limited cial pemphigoid lesions are frequently seen in erosions or ulcers of the oral mucosa may develop penicillamine-treated patients with rheumatoid after long-term and high-dose administration (Fig. Lowering the dose of the drug, and Bclassic pemphigus, cicatricial pemphigoid, bullous complex vitamin administration. Oral Lesions due to Drugs Phenytoin-induced Gingival the differential diagnosis includes fibrous gingival hyperplasia due to phenytoin, and nifedipine, ginHyperplasia gival fibromatosis, gingivitis, periodontitis, and Phenytoin is an antiepileptic agent widely used in leukemia. The lesions are usually A common side effect is fibrous gingival hyperreversible after cessation of the drug. Although the exact mechanism of gingival hyperplasia is not clear, the appearance and degree of the hyperplasia depend on the daily Nifedipine-induced Gingival dose, the duration of therapy, the state of oral Hyperplasia hygiene, and other local and systemic factors. The hyperplasia usually begins in the interdental papilNifedipine is a calcium channell-blocking agent lae and gradually involves the marginal and widely used in patients with coronary insufficiency attached gingiva. The exact mechanism of this the gingivae are firm, lobulated, slightly red, complication is unknown, although local alteraand painless, with little or no tendency to bleed tions in calcium metabolism seem to play a role. Usually, the enlargement of the gingiva Recently other calcium ion antagonists such is generalized. Rarely, hyperplasia may occur in as nitrendipine, felodipine, verapamil, and edentulous patients. The differential diagnosis includes cyclosporine the dose of the drug and the duration of and nifedipine-induced hyperplasia, idiopathic therapy, in association with the dental plaque and fibromatosis of the gingiva, and gingival hypertroother local factors, seem to play a role in the phy due to mouth breathing or leukemia. Careful oral hygiene, surgical excidence of gingival hyperplasia is not well known. Discontinuation of the drug or change to Recently, gingival hyperplasia has been observed another antiepileptic agent may result in regresin 51% of nifedipine-treated, renal transplant sion of the hyperplasia. Clinically, the gingiva is painless, enlarged, Cyclosporine-induced Gingival firm, lobulated, with no or little inflammation, Hyperplasia and usually partly covers the teeth (Fig. The overgrowth is more evident in the interdental Cyclosporine is a powerful immunosuppressive papillae and less commonly in the free and drug used to prevent organ transplant rejection attached gingiva. The gingival enlargement may and to treat lupus erythematosus and many other be localized or generalized and is most prominant autoimmune diseases. Gingival plasia due to other calcium-blocking drugs, hyperplasia is a common side effect occurring in hereditary gingival fibromatosis, mouth breathing between 30 to 70% of the patients receiving cycgingival hyperplasia, scurvy, and gingival hyperlosporine therapy. Gingivectomy is firm with focal lobulation, and little inflammation usually necessary, although hyperplasia may be (Fig. Several side-effects deficiency and is inherited as an autosomal domiof the drug have been reported. Recently, nail and skin edema of the larynx and tongue, which involves pigmentation as well as pigmentation of the oral the gastrointestinal tract, with abdominal pain, mucosa have been described usually shortly after nausea, vomiting, and diarrhea, also occur. Clinically, oral pigmentation acquired form is far more frequent and may be appears as irregular macules with a brown or dark due to food allergy, pharmaceuticals, local brown color. Angioneurotic edema of either type has a sudden onset, lasts usually for 24 to 48 hours, and may recur at variable time intervals. Clinically, it is characterized by painless, usually nonpruritic and smooth swelling involving the lips (Fig. The differential diagnosis should include trauma, surgical emphysema, cellulitis, cheilitis granulomatosa, Melkersson-Rosenthal syndrome, and cheilitis glandularis. Antihistamines, systemic steroids, and in acute severe cases epinephrine subcutaneously. Pigmentation due to Antimalarials Chloroquine and other antimalarials are used in the treatment of malaria and occasionally in patients with rheumatoid arthritis and lupus erythematosus. Long-term use may cause brown or black irregular pigmentation on the soft palate or other areas of the oral cavity (Fig. Cheilitis due to Retinoids Several side effects may appear during retinoid administration. The most common are dryness During the last decade, synthetic retinoids (13-ciswith scaling of the lips and dryness of the oral retinoic acid and the aromatic analogue of retinoic mucosa (Fig. Hair loss, palmoplantar scalacid, etretinate) have been introduced as new ing, thinning of the skin, pruritus, epistaxis, agents in the modern therapy of skin diseases. No They are extremely effective drugs in various severe complications have been observed after disorders of keratinization. Synthetic retinoids have recently been treatment and one year thereafter because of the used in the treatment of psoriasis, acne vulgaris, teratogenic and embryotoxic action of these ichthyosis, lichen planus, parapsoriasis en drugs. Metal and Other Deposits Amalgam Tattoo the differential diagnosis includes pigmented nevi, malignant melanoma, normal pigmentation, Amalgam deposition develops either as a result of and hematoma. Histopathologic examination and fragments in the oral tissues during dental filling radiographs are necessary on occasion to differenor surgical operations. In addition, during tooth tiate amalgam tattoo from other lesions of the oral extraction, fragments of amalgam restorations are mucosa with dark discoloration. Amalgam tattoo appears as a welldefined flat area with a bluish-black or brownish discoloration of varying size (Fig. Amalgam deposits usually occur in the gingiva, the alveolar mucosa, and the buccal mucosa. Metal and Other Deposits Bismuth Deposition Materia Alba of the Attached Gingiva Bismuth compounds were formerly used in the Materia alba is the result of accumulation of bactreatment of syphilis. It is antibiotics have replaced these compounds in the usually found at the dentogingival margins of pertreatment of syphilis. However, materia bismuth are now rarely encountered except in alba presenting as a white plaque along the vespatients who have been treated for syphilis in the tibular surface of the gingiva and the alveolar preantibiotic era and have poor oral hygiene. Less detached after slight pressure, leaving a red surfrequently, bismuth may be deposited in other face. Phleboliths Phleboliths are calcified thrombi that occur in veins and blood vessels. It is accepted that thrombi are produced by a slowing of the peripheral blood flow, and become secondarily organized and mineralized. Clinically, it appears as a hard, painless swelling of the oral soft tissues typically associated with hemangiomas, although in some cases there are no signs of hemangiomas (Fig. The differential diagnosis includes salivary gland calculi, calcified lymph nodes, and soft-tissue tumors. White plaques on the attached gingiva and the alveolar mucosa caused by materia alba accumulation.

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