CASESTUDY- 1

TYPE 2 DIABETES MELLITUS

Diabetes mellitus is a chronic metabolic disorder that prevents the body to

utilize glucose completely or partially. It is characterized by raised glucose

concentration in the blood and alterations in carbohydrate, protein, and fat

metabolism. This can be due to failure in the formation of insulin or liberation

or action. Since insulin is produced by the B-cells of the islets of Langerhans,

any decrease in the number of functioning cells will decrease the amount of

insulin that can be synthesized. Diabetes is classified into 2 types they are,

• Type I diabetes mellitus

• Type 2 diabetes mellitus

Type 2 Diabetes Mellitus:

 Type 2 diabetes mellitus is also known as adult onset diabetes and is

not insulin dependent form (non-insulin dependent diabetes mellitus). It is a

long term metabolic disorder that is characterized by high blood sugar, insulin

resistance, and relative lack of insulin. In this type, insulin may be produced by

pancreas but the action is impaired. This form oceurs mainly in adults and the

person is usually overweight. Acidosis is infrequent. The majority of patients

improve with weight loss and are maintained on diet therapy. Women who have

had large babies or large families are also prone to develop this type of diabetes

later in life.

Type 2 diabetes primarily occurs as a result of obesity and lack of

exercise. Some people are more genetically at risk than others. Type 2 diabetes

makes up about 90% of cases of diabetes, with the other 10% due primarily to

diabetes mellitus type 1 and gestational diabetes.

 Type 2 diabetes is partly preventable by staying a normal weight,

exercising regularly, and eating properly. Treatment involves exercise and

dietary changes. If blood sugar levels are not adequately lowered, the

medication metformin is typically recommended. Many people also require

insulin injections. Bariatrie surgery often improves diabetes in those who are

obese. Rate of type 2 diabetes have increased markedly since 1960 in parallel

with obesity. As of 2015 there were approximately 392 million people

diagnosed with the disease compared to around 30 million in 1985. Type 2

diabetes is associated with a ten year shorter life expectancy.

CAUSES OF TYPE 2 DIABETES MELLITUS

There are many factors that contribute to the development of diabetes

mellitus. Some arc,

• Weight: Being overweight is a primary risk factor for type 2 diabetes

• Geneties: Indians have a high genetic risk for diabetes.

• Lifestyle: Type 2 diabetes mellitus is associated with people who are

obese and underactive usually they overeat. The majority of middle

aged diabetie patients are obese people develop diabetes. Obesity

probably acts as a diabetogenic factor

• Age: Type 2 diabetes mellitus is principally a disease of the middle

aged and elderly.Half of all new cases of type 2 diabetes occur among

people over age 45.

• Fat distribution: The body stores fat primarily in the abdomen, the

risk of type 2 diabetes is greater than the body stores fat elsewhere,

such as hips and thighs.

• Inactivity: The less active, the greater the risk of type 2 diabetes.

Physical activity helps to control the weight, where the glucose is used

up as energy and makes the cells more sensitive to insulin

 • Prediabetes: Prediabetes is a condition in which the blood sugar level

is higher than normal, but not high enough to be classified as diabetes.

Left untreated, prediabetes often progresses to type 2 diabetes

• Polyeystic ovarian syndrome: For women, having polycystic ovarian

syndrome-a common condition characterized by irregular menstrual

periods, excess hair growth and obesity-increases the risk of diabetes.

• Pregnancy: During normal pregnancy the level of plasma insulin is

raised by the action of placental hormones thus placing a burden on

the insulin secreting cells of the pancreatic islets. The pancreas may be

unable to meet these demands in woman genetically predisposed to

develop both types of DM. the term "gestational diabetes* refers to

hyperglycemia occurring for the first time during pregnancy.

SIGNS AND SYMPTOMS OF DIABETES MELLITUS

• Hyperglycemia: A deficient supply of functioning insulin affects the

metabolism of carbohydrates, fats, protein, electrolytes and water and the

consequences of impairments are complex. When insulin is not being

produced or is ineffective, the formation of glycogen is decreased and the

utilization of glucose in the pheripheral tissues is reduced. As a

consequences the glucose that enters the circulation from various sources

is removed more slowly and hyperglycaemia follows.

• Glycosuria: When blood glucose level exceeds the renal threshold i.e.,

160-180mg per 100ml glycosuria occurs.

• Fluid and electrolyte balance: The loss of glucose in the urine

represents a wastage of energy and entails an increased climination of

water and sodium.

• Acidosis: With a deficiency in insulin, lipogenesis decreases and lipolysis

is greatly increased, these effects being of both immediate and long-range

consequences. The fatty acids released from adipose tissue or available

 by adsorption from the intestinal tract are oxidized by the liver to form

'ketone bodies" including acetoacetic acid,-hydroxybutyric acid and

acetone. The liver utilizes only limited quantities of ketones and released

them to circulation. In diabetes mellitus the ketones are produced at the

rate that far exceeds the ability of tissues to utilize them and the

concentration in blood is greatly increased. Acetone is excreted by the

lungs and gives the characteristic fruity odour to breath. Acetoacetic acid

and ß-hydroxy butyric acid and excreted in the urine (ketonuria). Being

fairly strong organic acids these ketones combine with base so that the

alkaline reserve is depleted and acidosis results.

• Polyuria and nocturia: Glycosuria occurs when the blood glucose level

is 180mg/dl. Glucose increases the osmolatlity of the glomerular filtrate

and thus prevents the reabsorption of water as the filtrate passes down the

renal tubules. In this way the volume of urine is markedly increased in

diabetes and polyuria and nocturia occur.

• Polydipsia and polyphagia: Polyuria leads to loss of water and

electrolvtes which results in thirst and polydipsia. patient feel excess

hunger as glucose is lost in urine and tissues are starved of glucose.

• Dehydration: As the blood glucose rises, the extracellular fluid becomes

hypertonic and water leaves the cells. If the loss of water and electrolytes

continue, depletion of extracellular fluid leads to the clinical features of

severe dehydration.

• Fatigue and loss of weight: Impaired utilization of carbohydrate results

in a sense of fatigue and 2 compensatory mechanisms operate to provide

alternative metabolie substrate. Both leads to loss of body tissue and

wasting may occur inspite of a normal or even increased intake of food.

• Increased excretion of potassium, magnesium and phosphorous:

Glycogen and protein present are associated with water and intracellular

electrolytes. As glycogen and protein are catabolized, glucose, water and

electrolytes, particularly potassium are released into the extracellular

 space. An increased urinary exertion of potassium. magnesium and

phosphorous therefore occurs in uncontrolled diabetes.

PRINCIPLE OF DIET:

The main principle of this diet is normal energy, moderate carbohydrate,

normal protein,low fat & high fiber.

FOODS TO BE INCLUDED:

Green leafy vegetables, fruits except banana, lemon, clear soups, onion,

mint, spices, salads, plain coffee or tea, skimmed and butter milk.

FOODS TO BE AVOIDED:

Simple sugar(glucose, honey syrup) sweets, dried fruits, cakes, candy,

fried food, alcohol, nuts, jaggery and sweetened juice.

CASE STUDY-1

DIABETIC MELLITUS

PATIENT PROFILE:

Name : Mr.Rajendran.R

Age/Gender : 60years/ male

Occupation : Farmer

Activity : Sedentary

Exercise : No

Alcohol : No

Smoking : No

Register no : 267030

IP No : 98651
Department : General Medicine

Date of Admission : 08/12/2023

Consultant : Dr.Saravanavel

MEDICAL HISTORY:

 Present complaint : Giddiness Since

 Past history : DM

 Diagnosis : DICA

ANTHROPOCENTRIC DATA:

 Height : 174 cm

 Weight : 55 kg

 BMI : 19.3 [Normal]

  IBW : 74

 Diet : Soft diet

BIOCHEMICAL DATA:

RBS/FBS 238

Haemoglobin 13.8 mg/dl

Urea 62 mg/dl

Creatinine 1.4
Sodium 123

Potassium 5.3

BIOPHYSICAL PARAMETER:

Blood pressure 110/ 80

Pulse rate 106

Body temperature 98.6°F

Respiration rate 20

Input 1800

Output 325

DIETARY ASSESSMENT:

 Food preferences: Non - Vegetarian

DIET PRESCRIPTION AND RECOMMENDATION:

 Energy : 1850

 Protein : 60

 Fat : 20

 Fluid : Normal

 Salt : Normal

24 HOURS RECALL MENU:

Early morning Milk

Breakfast Idly

Midmorning Baby corn soup

Lunch Rice, Sambar, Rasam, Spinach, curd ,egg

white

Evening -

Dinner Idly + sambar + coconut chutney

Bedtime Milk

CALCULATION FOR 24 HOURS RECALL MENU:

INGREDIENTS QTY ENERGY CHO PROTEIN FAT FIBRE

Rice 100g 356.3 78.24 7.9 0.5 5.98

Bengal gram 25g 82.2 11.6 5.3 0.9 3.5

Black gram dal 30g 97.2 15.3 6.9 0.4 3.18

Green gram dal 50g 146.8 23.06 11.2 0.5 9.3

Red gram dal 30g 99.2 16.5 6.5 0.4 6.09

Spinach 30g 7.3 0.6 0.19 0.6 4.38

Baby corn 25g 21.9 2.9 0.8 0.3 1.5

Tomato 30g 5.8 0.8 0.27 0.14 0.4

Tamarind 10g 28.8 6.7 0.29 0.01 0.7

Chilli 5g 11.8 1.4 0.6 0.3 0.4

Coriander leaves 10g 3.8 0.5 0.2 0.06 0.5

Curry leaves 5g 3.17 0.2 0.37 0.05 1.52

Onion 30g 14.8 2.8 0.45 0.07 0.2

Turmeric 6g 16.8 2.9 0.4 0.3 0.1

Coconut 15g 40.8 0.6 0.5 6.2 0.2

Mustard 5g 25.4 1.14 0.9 1.9 0.01

Milk 300ml 218.6 14.8 9.7 13.4 -

Oil 5ml 45 - - - -

Total 1560.3 215.5 69.9 26.5 70.0

HOSPITAL MENU

TIMING MENU QUANTITY

6:00AM Milk 150ml

8.00AM Idly 3nos

Corriander chutney 1 katori

10.00AM Corn soup 150ml

12:00PM Rice 1 cup

Drum stick sambar 1 katori

Lady’s finger porriyal 1 katori

Greens kootu 1 katori

Aviyal 1 katori

2:00PM Watermelon juice 200ml

4:00PM Milk 150ml

Sundal 1 katori

8:00PM Idly 3 nos

Sambar 1 katori

10:00PM Milk 150ml

CALCULATION FOR HOSPITAL MENU

INGREDIENTS QTY ENERGY CHO PROTEI FAT FIBRE

Rice(raw) 100g 356.3 78.2 7.9 0.5 3.32

Rice(parboiled) 100g 351.5 77.1 7.8 0.5 4.3

Black gram dal 50g 162.05 25.5 11.5 0.8 5.6

Lentil dal 75g 161.2 26.2 12.1 0.3 10.33

Spinach 25g 6.09 0.5 0.5 0.1 3.5

Broad beans 5g 1.46 6.1 0.1 0.0 0.87

Red gram 30g 199.23 16.5 6.5 0.4 0.9

Beans 10g 2.43 0.26 0.24 0.02 0.7

Lady’s finger 25g 6.87 0.90 0.52 0.05 0.8

Tomato 30g 5.87 0.8 0.27 0.14 2.2

Orange 20g 7.4 1.5 0.14 0.02 0.2

Watermelon 20g 4.06 0.7 0.12 0.03 4.2

Corn 20g 4.6 2.3 0.53 0.26 1.5

Carrot 5g 1.6 0.27 0.03 0.02 0.4

Potato 5g 3.48 0.74 0.07 0.01 3.2

Drum Stick 5g 1.5 0.3 0.04 0.0 0.2

Corriander 5g 1.5 0.09 0.17 0.03 1.5

Curry leaves 5g 3.17 0.2 0.3 0.05 4.2

Onion 10g 4.8 0.9 0.15 0.02 0.8

Chilli 15g 6.8 6.9 0.39 0.10 0.7

Cumin 5g 15.2 1.13 0.69 0.83 2.2

Turmeric powder 5g 14.0 2.4 0.38 0.25 0.9

Mustard seeds 5g 50.9 0.84 0.97 2 0.7

Bengal gram 25g 82.2 11.6 5.3 1.3 7.4

Milk 200ml 145.7 9.8 6.57 8.96 -

Total 1650.0 260.89 63.88 23.07 60.0

SUGGESTED MENU

TIMING MENU QUANTITY

Early morning Milk without sugar 100ml

Breakfast Black rice Idly 3nos

Mint chutney 1 katori(small)

Mid morning Pomagrante Juice 100ml

Lunch Red Rice 200 g

DrumStick sambar 1 katori(small)

Egg white 1
 Carrot Poriyal 1 katori(small)

Evening Soaked Batham 3 Nos

Milk 100ml

Dinner Ragi Dosa 3 Nos

Parupu Sambar 1 katori(small)

Bedtime Skimmed milk 100ml

CALCULATION FOR SUGGESTED MENU

INGREDIENTS QTY ENERGY CH PROTEIN FAT FIBRE

Ragi 100g 320 40.0 4.29 1.9 7.4

Black Rice 50g 283 75.5 8.89 3.33 -

Red Rice 50g 222 47.4 5.7 2.8 -

Lentil 50g 171 25.9 14.7 0.43 0.4

Black gram 50g 173.5 29.8 12 0.7 0.45

Bengal gram 50g 143.5 19.7 9.3 2.5 3.5

Tomato 30g 5.8 0.27 0.8 0.14 0.7

Pomegranate 75g 48.75 10.87 1.2 0.075 3.82

Red chilli 10g 3.8 0.56 0.2 0.06 1.5

Drum Stick 25g 23 3.125 1.67 0.425 0.57

Mint Leaf 50g 24 2.9 2.4 0.3 1.0

Turmaric Powder 20g 69.8 30.88 1.26 1.02 0.52

Curry leaves 10g 3.17 0.22 0.37 0.01 0.4

Garlic 15g 18.75 3.5 0.9 0.02 0.8

Ginger 10g 5.4 0.8 0.2 0.08 0.7

Onion 50g 14.8 0.45 2.8 0.07 2.2

Carrot 30g 14.4 3.18 27 0.06 0.36

Coconut 20g 81.7 1.26 0.1 8.2 0.9

Milk 200ml 145.7 9.5 6.5 8.9 -

Egg white 30g 15.7 - 3.7 0.07 -

Total 1900 426.8 70.3 20 28.255

Conclusion

The patient named Mr. Mr.Rajendran.R aged 60 years was admitted in the Hospital

for the complaint of Giddiness Diagnosed in the hospital As Diabetic Mellitus

Medication along With the diet given for the patient is soft diet prescribed in the

Hospital and supervised Regularly, the treatment helped the patient

For fast recovery.

Case study 2

RTF

INTRODUCTION:

A subdural hematomas occurs when a blood vessel in the space between the skull and

the brain (the subdural space) is damaged. Blood escapes from the blood vessel,

leading to the formation of a blood clot (hematomas) that places pressure on the brain

and damages it.

SYMPTOM:

 A headache that keeps getting worse.

 Feeling and being sick.

 Confusion.

 Personality changes, such as being unusually aggressive or having rapid mood

swings.

 Feeling drowsy and finding it difficult to keep your eyes open.

  Speech problems, such as slurred speech

CAUSES:

 Subdural haematomas are usually caused by a head injury.

 Head injuries that cause subdural haematomas are often severe, such as from a

car crash, fall or violent assault.

RISK FACTOR:

 Old age

 Alcoholism

 diabetes mellitus

 arachnoid cysts

 coagulopathy

 anticoagulant (ACTh) and antiplatelet drugs.

COMPLICATIONS:
Brain herniation (pressure on the brain severe enough to cause coma and death)

Persistent symptoms such as memory loss, dizziness, headache, anxiety, and difficulty

concentrating. Seizures. Short-term or permanent weakness, numbness, difficulty

speaking.

PREVENTION:

 Abstain. The most effective way to avoid STIs is to not have (abstain from)

sex.

 Stay with one uninfected partner.

 Wait and test.

 Get vaccinated.

 Use condoms and dental dams consistently and correctly.

 Don’t drink alcohol excessively or use drugs.

 Communicate.

 Consider male circumcision

DIAGNOSIS:

 Blood tests. Blood tests can confirm the diagnosis of HIV or later stages of

syphilis.

 Urine samples. Some STIs can be confirmed with a urine sample.

 Fluid samples. If you have open genital sores, your doctor may test fluid and

samples from the sores to diagnose the type of infection.

PRINCIPAL OF DIET:

 To maintain a good nutritional status.

 To correct nutrient deficiencies which may have occurred due to the disease.

 To afford rest to the whole body or to the specific organ affected by the disease.

 The diet should contain a good amount of dietary fiber and water as well. A

balanced diet includes a combination of protein-rich pulses, sprouted seeds etc.

SUBARACHNOID HAEMORRHAGE

Cause

A subarachnoid haemorrhage is most often caused by a burst blood vessel in the brain

(a ruptured brain aneurysm).

A brain aneurysm is a bulge in a blood vessel caused by a weakness in the blood

vessel wall, usually at a point where the vessel branches off.

As blood passes through the weakened vessel, the pressure causes a small area to

bulge outwards like a balloon.

Occasionally, this bulge can burst (rupture), causing bleeding around the brain. More

than 8 out of every 10 subarachnoid haemorrhages happen in this way.

A brain aneurysm doesn’t usually cause any symptoms unless it ruptures.

But some people with unruptured aneurysms experience symptoms such as:

Sight problems
Pain on one side of the face or around the eye

Persistent headaches

It’s not known exactly why brain aneurysms develop in some people, although certain

risk factors have been identified.

These include:

Smoking

High blood pressure

Excessive alcohol consumption

A family history of the condition

Severe head injury

Autosomal dominant polycystic kidney disease (ADPKD)

Most brain aneurysms won’t rupture but a procedure to prevent subarachnoid

haemorrhages is sometimes recommended if they’re detected early.

Symptoms of SAH

When SAH develops, it has several symptoms. The main symptom is a sudden, severe

headache, which is more intense at the base of the skull. It’s often described as the

worst headache people have ever experienced. Some people may even feel a popping

sensation in their head before the hemorrhage begins.

You may also have:

Severe head, neck, and shoulder pain

Seizures

Confusion and rapid loss of alertness

Nausea

Vomiting

Dizziness

Difficulty walking or standing

Vision changes

Difficulty speaking or understanding others

Loss of consciousness

The symptoms of SAH come on suddenly, and you may lose consciousness quickly.

Seek emergency medical attention right away if you experience any of these

symptoms combined with a severe headache.

CASE STUDY-2

RYLES TUBE FEEDING

PATIENT PROFILE:

Name : Mahajabeen.H

Age/Gender : 48years/Female

Occupation : House wife

Activity : Sedentery

Exercise : Regular

Alcohol : No

Smoking : No

Register no : 260777

IP no : 98678
Department : General Medicine

Date of admission : 08/12/2023

Consultant : Dr.A.MEENA

MEDICAL HISTORY:

 Present complaint : Palpitation

 Past history : DM

 Diagnosis : SVT

ANTHROPOCENTRIC DATA:

 Height : 160 cm

 Weight : 59kg

 BMI : 22.6 [Normal]

  IBW : 60

 Diet : RTF Liquid diet

BIOCHEMICAL DATA:

Investigation Result

Haemoglobin 11.6 mg/dl

Urea 60 mg/dl

Creatinine 0.8

Sodium 148

Potassium 3.0

Blood sugar -
BIOPHYSICAL PARAMETER:

Blood pressure 110/80

Pulse rate 109

Body temperature 98°F

Respiration rate 26

Input 1100

Output 400

DIETARY ASSESSMENT :

 Food preferences: Non Vegetarian

DIET PRESCRIPTION AND RECOMMENDATION:

 Energy : 1800

 Protein : 60

 Fat : 20

 Fluid : Normal

 Salt : Normal

24 HOURS RECALL MENU:

6AM Milk

8AM Blend

10AM Egg flip

12PM Blend

2PM Egg flip

4PM Milk

6PM Blend

8PM Blend

10PM Milk

CALCULATION FOR 24 HOURS REALLY MENU:

INGREDIENTS QTY ENERGY CHO PROTEIN FAT FIBRE

Rice 300g 106 234.6 23.82 1.56 3.4

Milk 400ml 291 19.7 12.8 17.9 -

Egg 200g 89.3 - 21.6 0.12 -

Coconut Oil 30ml 270 - - - -

Total 1719.3 254.3 58.22 19.5 3.4

HOSPITAL MENU

TIMING MENU QUANTITY

6:00AM Milk 150ml

8.00AM Blend 200ml

10.00AM Egg flip 200ml

12:00PM Blend 200ml

2:00PM Egg flip 200ml

4:00PM Milk 200ml

6:00PM Blend 200ml

8:00PM Blend 200ml

10:00PM Milk 150ml

CALCULATION FOR HOSPITAL MENU

INGREDIENTS QTY ENERGY CHO PROTEIN FAT FIBRE

Ensure 10g 42.9 - 1.9 1.19 2

Rice Flour 350g 1230 273.8 27.79 1.8 10.4

Milk 400ml 291 19.7 12.8 17.9 -

Egg 200g 89.3 - 21.6 0.12 _

Coconut oil 30ml 270 - - 30 -

Total 1923.2 293.5 64.09 50.8 12.4

SUGGESTED MENU

TIMING MENU QUANTITY

6AM Milk+Ensure 150ml

8AM Rice Kanjee Filter 200ml

10AM Health Mix Kanjee Liquid 150ml

12PM Crab Musscle Soup 200ml

2PM Panner Milk 200ml

4PM Milk+Ensure 200ml

6PM Amaranth Steam Soup Filter 200ml

8PM Milk +Ensure 150ml

CALCULATION FOR SUGGESTED MENU

INGREDIENTS QTY ENERGY CHO PROTEIN FAT

Ensure 30g 143 18.5 - 3.15

Rice 200g 690 156.4 15 1

Milk 400ml 226 17.6 5.8 16.4

Bajra 25 19.25 16.8 2.9 1.25

Maize 25 85.5 16.5 2.7 0.9

Crab 50 29.5 1.65 4.5 0.55

Tomato 20 4 0.78 0.18 0.04

Small Onion 20 11.8 2.52 2.32 0.02

Black Pepper 10g 30.4 4.92 2.385 0.68

Red Chilli 15g 56.9 4.74 2.385 0.93

Ginger 5g 3.35 0.61 0.115 0.04

Turmaric 10g 34.9 6.94 0.6 0.51

Garlic 10g 14.5 2.98 0.63 0.01

Amaranth steam 100g 260 19 0.9 0.1

 Big Oninon 5g 5 1.11 0.12 0.1

Curry Leaves 10 10.8 1.87 0.61 0.1

Total 1700 256.42 50.1 25.48

Conclusion

The patient named Mrs. Mahajabeen aged 48 years was admitted in the Hospital
for the complaint of Pulpitation and diagnosed in the hospital as SVT along With the

diet given for the patient is RTF liquid diet prescribed in the hospital and supervised

regularly, the treatment helped the patient for fast recovery.

CASE STUDY-3

CORONARY ARTERY DISEASES

Coronary Artery Diseases (CVD) is a class of diseases that involve the heart or

blood vessels. Cardio Artery Diseasesincludes coronary artery diseases (CAD)

such as angina and myocardial infarction (commonly known as a heart attack).

Other CVDs include stroke, heart failure, hypertensive heart disease, rheumatic

heart disease, cardiomyopathy, heart arrhythmia, congenital heart disease,

valvular heart disease, carditis, aortic aneurysms, peripheral artery disease,

thromboembolie disease, and venous thrombosis. Coronary artery diseases,

stroke, heart failure, hypertensive heart disease, rheumatic heart disease,

cardiomyopathy

This may be caused by high blood pressure, smoking, diabetes, lack of

exercise, obesity, high blood cholesterol, poor diet, and excessive alcohol

consumption, among others. High blood pressure results in 13% of CVD deaths,
while tobacco results in 9%, diabetes 6%, lack of exercise 6% and obesity 5%.

Rheumatic heart disease may follow untreated strep throat.

It is estimated that 90% of CVD is preventable. Prevention of atherosclerosis

involves improving risk factors through: healthy eating, exercise, avoidance of

tobacco smoke and limiting alcohol intake. Treating risk factors, such as high

blood pressure, blood lipids and diabetes is also beneficial. Cardiovascular

diseases are the leading cause of death globally. In 17.9 million deaths (32.1%)

in 2015, up from 12.3 million (25.8%) in 1990.

CAUSES OF CARDIO VASCULAR DISEASES

There are many risk factors for heart diseases: age, gender, tobacco use,

physical inactivity, excessive alcohol consumption, unhealthy diet, obesity,

genetic predisposition and family history of cardiovascular disease, raised blood

pressure (hypertension), raised blood sugar (diabetes mellitus), raised blood

cholesterol (hyperlipidemia), undiagnosed celiac disease, psychosocial factors,

poverty and low educational status, and air pollution. While the individual

contribution of each risk factor varies between different communities or ethnie

groups the overall contribution of these risk factors is very consistent. Some of

these risk factors, such as age, gender or family history/genetic predisposition,

are immutable; however, many important cardiovascular risk factors are

modifiable by lifestyle change, social change, drug treatment (for example

prevention of hypertension, hyperlipidemia, and diabetes).

People with obesity are at increased risk of atherosclerosis of the coronary

arteries,

• Geneties: Genetic factors influence the development of Cardio Artery

Diseasesin men who are less than 55 years-old and in women who are

less than 65 years old. Cardio Artery Diseasesin a person's parents

increases their risk by 3 fold, but usually their individual influence is

small, and genetic contributions to Cardio Artery Discasesare poor

• Age: Age is by far the most important risk factor in developing

cardiovascular or heart discases, with approximately a tripling of risk

with each decade of life.

• In men, this increase levels off around age 45 to 50 years. In women, the

increase continues sharply until age 60 to 65 years.

• Sex: Men are at greater risk of heart disease than pre-menopausal women.

Once past menopause, it has been argued that a woman's risk is similar to

a man's. Coronary heart discases are 2 to 5 times more common among

middle-aged men than women. In a study done by the World Health

Organization, sex contributes to approximately 40% of the variation in

sex ratios of coronary heart discase mortality.

• Tobacco: Cigarettes are the major form of smoked tobacco. Risks to

health from tobacco use result not only from direct consumption of

tobacco, but also from exposure to second-hand smoke. Approximately

10% of Cardio Artery Diseases is attributed to smoking.

• Physical activity: Insufficient physical activity defined as less than 5 x

30 minutes of moderate activity per week, or less than 3 x 20 minutes of

vigorous activity per week is currently the fourth leading risk factor for

mortality.

• Diet: High dietary intakes of saturated fat, trans-fats and salt, and low

intake of fruits, vegetables and fish are linked to cardiovascular risk,

although whether all these associations are a cause is disputed. The World

Health Organization approximately 1.7 million deaths worldwide to low

fruit and vegetable consumption. The amount of dietary salt consumed is

also an important determinant of blood pressure levels and overall

cardiovascular risk. Frequent consumption of high-energy foods, such as

processed foods that are high in fats and sugars, promotes obesity and

may increase cardiovascular risk.

• Socio economic disadvantage: Cardio Artery Diseases affects low- and

middle-income countries even more than high-income countries, but

 within high-income countries low income and low educational status are

consistently associated with greater risk of cardiovascular disease.

• Air pollution: Particulate matter has been studied for its short- and long-

term exposure effects on cardiovascular disease.

• Work, depression, toxins like silica dust also contribute to the

development to the cardio vascular discases.

SIGNS AND SYMPTOMS OF CARDIOVASCULAR DISEASES

Symptoms of heart diseases includes the following:

• Chest pain

• Chest tightness

• Chest discomfort

• Shortness of breath

• Pain
• Numbness

• Weakness or coldness in legs and arms

• Pain in the neck, jaw, throat, upper abdomen or back

• Palpitation

• Dizziness

• Easily getting short of breath during exercise or activity

• Fatigue

• Dry or persistent cough

• Fainting

PRINCIPLE OF DIET:

Normal calories, carbohydrate, protein, low fat especially saturated fats and

adequate vitamins and minerals except sodium

FOODS TO BE INCLUDED:

Whole grain cereals, legumes, nuts, fruits and vegetables, oily fish (omega 3

fatty acids), vitamin E rich foods, garlic.

FOODS TO BE AVOIDED:

Fried and processed foods, refined foods, poultry skin, added salt, high fat diet

CASE STUDY-3

CORONARY ARTERY DISEASE

PATIENT PROFILE:

Name : Mrs.Santha

Age/Gender : 73 years/male
Occupation : House wife

Activity : Moderate

Exercise : None

Alcohol : no

Smoking : no

Register no : 260488

IP no : IP 98562

Department : Neurology

Date of admission : 05-12-2023

Consultant : Dr. Ashik Meeran

MEDICAL HISTORY:

 Present complaint : Decrease Response

  Past history : Hypertension, , DM

 Diagnosis : CAD

ANTHROPOCENTRIC DATA:

 Height : 160 cm

 Weight : 50 kg

 BMI : 19.53

 IBW : 60

 Diet : Soft diet

BIOCHEMICAL DATA:
 Investigation Result

Haemoglobin 10.5mg/dl

Urea 76 mg/dl

Creatinine 1.3

Sodium 163

Potassium 2.5

Blood sugar 103 mg/dl

BIOPHYSICAL PARAMETER:

Blood pressure 130/70

Pulse rate 90

Body temperature 100°F

Respiration rate 27
 Input 200

Output 300

DIETARY ASSESSMENT :

Food preferences: Non - Vegetarian

DIET PRESCRIPTION AND RECOMMENDATION:

Energy : 1700

Protein : 60

Fat : 20

Fluid : Normal
Salt : Normal

24 HOURS RECALL MENU:

Timing Meal Menu Quantity

6:00AM Early morning Milk 200ml

8:00AM Breakfast -------- -

10: 00AM Midmorning --------- -

12:00AM Lunch Rice,Sambar, 1kattori

4:00 AM Evening Milk 150ml

8:00AM Dinner Idly + sambar + 1

coconut chutney
 1 kattori

10:00 AM Bedtime - -

CALCULATION FOR 24 HOURS RECALL MENU:

INGREDIENT QTY ENERGY CHO PROTEIN FAT FIBRE

Rice 75g 265.2 56.1 6.87 0.5 5.7

Rice parbolied 100g 351.5 77.6 7.81 0.3 4.2

Black gram dal 35g 113.4 17.85 8.07 0.9 5.7

Lentil 50g 161.2 26.26 12.17 0.4 3.4

Broad beans 10g 2.93 0.2 0.38 0.5 10.0

Franch beans 10g 2.43 0.26 0.24 0.4 0.9

Tomato 10g 1.95 0.27 0.09 0.6 1.0

Carrot 10g 3.32 0.55 0.09 0.3 3.4

Chilli powder 15g 6.84 0.94 0.39 0.2 0.4

Curry leaves 5g 3.17 0.22 0.37 0.14 5.2

Onion 10g 4.8 0.05 0.15 0.01 0.1

Cumin seeds 5g 15.2 1.13 0.6 0.3 0.08

Turmeric powder 5g 14.6 2.46 0.38 0.06 0.03

Mustard seeds 5g 25.4 0.8 0.97 0.05 0.02

Coconut 25g 156 2.00 1.18 10.5 5.7

Milk 200ml 145.7 9.8 6.52 8.9 -

Total 1515 196.9 46.9 26.5 45.83

HOSPITAL MENU
TIMING MEAL MENU QUANTITY

6:00AM Early morning Milk 150ml

8:00AM Break fast Idly 3nos

Corriander 1 katori

chutney

10:00AM Mid morning Corn soup 150ml

12:00PM Lunch Rice 1 cup

Raddish sambar 1 katori

Lady’s finger 1 katori

porriyal

Greens kootu 1 katori

Aviyal 1 katori

2:00PM Mid afternoon Watermelon juice 200ml

4:00PM Evening Milk 150ml

 Sundal 1 katori

8:00PM DINNER Idly 3 nos

Sambar 1 katori

Coconut chutney 1 katori

10:00PM Bed time Milk 150ml

CALCULATION FOR HOSPITAL MENU

INGREDIENTS QTY ENERGY CHO PROTEI FAT

Rice(raw) 100g 356.3 78.2 7.9 0.5

Rice(parboiled) 100g 351.5 77.1 7.8 0.5

Black gram dal 50g 162.05 25.5 11.5 0.8

Lentil dal 75g 161.2 26.2 12.1 0.3

Spinach 25g 6.09 0.5 0.5 0.1

Broad beans 5g 1.46 6.1 0.1 0.0

Red gram 30g 199.23 16.5 6.5 0.4

Beans 10g 2.43 0.26 0.24 0.02

Lady’s finger 25g 6.87 0.90 0.52 0.05

Tomato 30g 5.87 0.8 0.27 0.14

Orange 20g 7.4 1.5 0.14 0.02

Watermelon 20g 4.06 0.7 0.12 0.03

Corn 20g 4.6 2.3 0.53 0.26

Carrot 5g 1.6 0.27 0.03 0.02

Potato 5g 3.48 0.74 0.07 0.01

Raddish 5g 1.5 0.3 0.04 0.0

Corriander 5g 1.5 0.09 0.17 0.03

Curry leaves 5g 3.17 0.2 0.3 0.05

Onion 10g 4.8 0.9 0.15 0.02

Chilli 15g 6.8 6.9 0.39 0.10

Cumin 5g 15.2 1.13 0.69 0.83

Turmeric powder 5g 14.0 2.4 0.38 0.25

Mustard seeds 5g 50.9 0.84 0.97 2

Coconut 15g 61.3 0.94 0.57 6.2

Bengal gram 25g 82.2 11.6 5.3 1.3

Milk 200m 145.7 9.8 6.57 8.96

Total 1536 260.89 63.88 23.07

SUGGESTED MENU

TIMING MENU QUANTITY

Early morning Milk without sugar 100ml

Breakfast Multigram Idli 3nos

Lentil veg sambar 1 katori(small)

Mid-morning Pear fruit 100g

Lunch Veg Pulavoo 200g

Yoguart 1 katori

Cucumber + Mint 100g

Evening Soya beens sprouts 30g

Dinner Bajera Rotti 3

Tomato, Chutney 1 katori(small)

Bedtime Milk without sugar 100ml

CALCULATION FOR SUGGESTED MENU

INGREDIENT QTY ENERG CHO PROTEI FAT FIBR

S Y N E

Rice 150g 519 97.75 8.5 0.62 0.25

Bajara 125g 451.25 84.37 14.5 6.25 1.3

Black gram 25g 86.75 14.9 6 0.35 0.225

Maize 25g 82 18 1.8 0.32 0.9

Lentil 35g 120 25.65 8.78 0.24 0.24

Capsicum 20g 3.25 0.37 0.22 0.07 0.4

Carrot 40g 19.2 4.2 0.36 0.08 0.48

Grean Peas 40g 37.2 6.3 2.8 0.04 1.6

Tomato 30g 5.8 0.27 0.8 0.14 0.78

Cucumber 25g 3.25 0.625 0.1 0.02 0.1

Small Oninon 35g 20.65 4.41 0.63 0.03 0.1

Big Onion 20g 10 2.2 0.2 0.02 0.12

Peas 100g 52 11.9 0.6 0.2 1

Mint Leafs 10g 4.8 0.5 0.4 0.06 0.2

Soya beans 30g 7.5 2.03 7.5 3.8 4.5

Red Chilli 20g 47.32 5.89 2.54 1.28 6.23

 Garlic 15g 18.75 3.5 0.9 0.02 0.51

Turmeric 5g 14.02 2.46 0.38 0.25 0.32

powder

Milk 200m 145.7 9.5 6.5 8.9 -

Total 1803.0 498.2 62.715 22.4 20.5

Conclusion

The patient named Mrs. Santha .G aged 73 years was admitted in the Hospital

For the complaint of Decreased Response and Hypertension and diagnosed in the

hospital as coronary artery disease Medication along With the diet given for the
patient is soft diet Prescribed in the Hospital and supervised Regularly, the treatment

helped the patient For fast recovery.

CASE STUDY IV

CHRONIC KIDNEY DISEASE

Introduction :

Chronic kidney disease includes conditions that damage your kidneys and decrease

their ability to keep you healthy by filtering wastes from your blood. If kidney disease

worsens, wastes can build to high levels in your blood and make you feel sick. You

may develop complications like:

•High blood pressure

• Anemia (low blood count)

• Weak bones

• Poor nutritional health

• Nerve damage

Kidney disease also increases your risk of having heart and blood vessel disease.

These problems may happen slowly over a long time. Early detection and treatment

can often keep chronic kidney disease from getting worse. When kidney disease

progresses, it may eventually lead to kidney failure, which requires dialysis or a

kidney transplant to maintain life.

Causes :

Diabetes and high blood pressure, or hypertension, are responsible for two-thirds of

chronic kidney disease cases.

Diabetes: Diabetes occurs when your blood sugar remains high. Over time,

unmanaged blood sugar can cause damage to many organs in your body, including the

kidneys and heart and blood vessels, nerves, and eyes.

High blood pressure: High blood pressure occurs when your blood pressure against

the walls of your blood vessels increases. If uncontrolled or poorly controlled, high

blood pressure can be a leading cause of heart attacks, strokes, and chronic kidney

disease. Also, chronic kidney disease can cause high blood pressure

Symptoms

• Feel more tired and have less energy

• Have trouble concentrating

• Have a poor appetite

• Have trouble sleeping

• Have muscle cramping at night

• Have swollen feet and ankles

• Have swollen fet and anklesves, especilly in the morning

• Have dry, itchy skin

• Need to urinate more often, especially at night

Risk factors:

• Diabetes

• High blood pressure

• Heart (cardiovascular) disease

• Smoking

• Obesity

• Being Black, Native American or Asian American

•Family history of kidney disease

• Abnormal kidney structure

• Older age
Diagnosis:

Blood tests. Kidney function tests look for the level of waste products, such as

creatinine and urea, in your blood.

Urine tests. Analyzing a sample of your urine can reveal abnormalities that point to

chronic kidney failure and help identify the cause of chronic kidney disease.

Imaging tests. Your doctor might use ultrasound to assess your kidneys' structure and

size.

Other imaging tests might be used in some cases.

Removing a sample of kidney tissue for testing. Your doctor might recommend a

kidney biopsy, which involves removing a sample of kidney tissue. Kidney biopsy is

often done with local anesthesia using a long, thin needle that's inserted through your

skin and into your kidney. The biopsy sample is sent to a lab for testing to help

determine what's causing your kidney problem.

Treatment:
• Make and keep your regular healthcare provider/nephrologist (kidney specialist)

visits. These providers monitor your kidney health

• Manage your blood glucose (sugar) if you have diabetes.

• Avoid taking painkillers and other medications that may make your kidney disease

worse.

• Manage your blood pressure levels.

. Follow a kidney-friendly diet. Dietary changes may include limiting protein, eating

foods that reduce blood cholesterol levels and limiting sodium (salt) and potassium

intake.

Medications:

• An angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor

blocker (ARB) to lower your blood pressure.

•Phosphate binder if your kidneys can't eliminate phosphate.

• A diuretic to help your body eliminate extra fluid.

• Medications to lower cholesterol levels.

Erythropoietin to build red blood cells if you're anemic.

• Vitamin D and calcitriol to prevent bone loss.

Principle of diet

•Limiting fluids,

• low-protein diet

• limiting salt, potassium, phosphorous, and other electrolytes

• getting enough calories.

CASE STUDY:4

Name : Mr.Karthikeyan.S

Age/Gender : 63years/ male

Occupation : -

Activity : -

Exercise : No

Alcohol : No

Smoking : No

Register no : 249054

IP No : 98489

Department : Nephrology

Date of Admission : 04-12-2023

Consultant : DR MARTIN DANIEL.A

 MEDICAL HISTORY:

 Present complaint : PEADAL EDEMA

 Past history : DM / HTN

 Diagnosis : CKD / PEADAL EDEMA

ANTHROPOCENTRIC DATA:

 Height : 170 cm

 Weight : 70kg

 BMI : 24.2 [Over weight ]

 IBW : 70

 Diet : Soft diet

BIOCHEMICAL DATA:

RBS/FBS 235

Haemoglobin 10.9 mg/dl

Urea 6.2 mg/dl

Creatinine 2.6

Sodium 132

Potassium 3.5

BIOPHYSICAL PARAMETER:

Blood pressure 120/80

Pulse rate 81

Body temperature 97°F

Respiration rate 32

Input 900

Output 700

DIETARY ASSESSMENT:

 Food preferences: Vegetarian

DIET PRESCRIPTION AND RECOMMENDATION:

 Energy : 1500

 Protein : 60

 Fat : 20

 Fluid : Normal

 Salt : Normal
24 HOURS RECALL MENU:

Early morning Milk

Breakfast Wheat semolina

Midmorning Baby corn soup

Lunch Rice, Sambar, Rasam, Spinach, curd,egg

white

Evening Milk + peas

Dinner Idly + sambar + coconut chutney

Bedtime -

Nutritive value for 24 hrs recall method

Ingredients Quantity Energy Carbs(gm Protein Fat(gm) Fibre g

 kcal ) (gm)

Ragi 75 g 240.5 50.1 5.37 1.44 2.78

Rice 100 g 351.5 77.16 7.81 0.55 7.80

( parboiled)

Wheat flour 50 g 160.1 32.08 5.2 0.76 8.62

Beans 10 g 1.31 0.138 1.12 0.80 0.20

Tomato 10 g 1.95 0.27 0.09 0.04 1.21

Carrot 15 g 1.28 1.90 1.14 0.09 0.71

Green chilli 5 g 3.56 0.53 0.16 0.05 0.08

Coriander 10 g 7.36 0.28 0.55 0.10 0.4

leaves

Curry 5g 3.17 0.22 0.37 0.05 0.4

leaves

Onion 10 g 5.66 1.15 0.18 0.01 0.7

Mustard 3g 15.2 0.50 0.58 1.20 4.71

seed

Lemon 5 ml 1.82 0.34 0.02 0.03 10.3

Milk 200 ml 145.7 9.8 6.52 8.96 0.02

Coconut 50 g 204.4 3.15 1.92 20.6 11.2

Total 1143kcal 177.6gm 29.34gm 33.61g 25.71gm

m
Hospital Menu

Interval Timing Menu Quantity

Early morning 6:00 Milk 150 ml

Breakfast 8:00 Idiyapam 3 no

Chow chow kuruma 1 small katori

Mid-morning 10:00 Whaet rava payasam 1 katori

Lunch 1:00 Rice 1 katori

Drum stick sambar 1 small katori

Pumkin Kootu 1 small katori

Puchakeerai kadayal 1 small katori

Salat 1 small katori

 Curd 1 small katori

Rasam 1 small katori

Evening 4:00 Groundnut Puffed 1 small katori

Dinner 8:00 Onino Oothapam 3 Nos

Sambar 1 small katori

Bed time 10:00 Milk 150 ml

Nutritive value for hospital Menu:

Ingredients Quantity Energy Cho Protein Fat Fibre

Rice 100 g 351.5 77.1 7.8 0.5 0.4

Rice floor 50g 353.7 76.7 7.4 1.1 3.1

Wheat 100 g 333.6 68.4 11.3 9.8 10.2

Drum Stick 50g 14.7 1.8 1.3 0.6 3.4

Pumpkin 50g 12.3 2.1 0.4 0.9 1.2

Groundnut 50g 260.4 8.6 11.8 19.8 5.1

Onion 10g 46.8 8.9 0.1 0.02 0.1

Carrot 10g 3.3 0.5 0.9 0.4 0.1

Spinach 50g 12.1 1.2 1.7 0.3 1.1

Curd 100ml 60 3 3.1 4 -

Milk 200 ml 145.79 9.88 6.52 0.96 -

Total 1690.5 249.3 62.1 22.4 20.6
Suggested Menu:

Interval Timing Menu Quantity

Early 6:00 Milk without sugar 100 ml

morning

Breakfast 8:00 Rava Idly 3 Nos

With sambar 1 katori

Mid- 10:00 Oats Kanjee 50ml

morning

Lunch 1:00 Samai Rice 150g

Sambar 1small katori

 Ladies finger poriyal 1small katori

Rasam 1small katori

Low fat Curd 1small katori

Egg White 1Nos

Evening 4:00 Black channa 75g

Dinner 8.00 Beet Root Chapathi 2 nos

Veg Curry 1small katori

Bed time 10:00 Skimmed Milk 100ml

Nutritive value for suggested Menu:

Ingredients Quantity Energy Cho Protein Fat Fibre

Semolina 100g 261 74.8 78 0.8 0.2

Milk 200 ml 137 13.2 9.6 4.5 -

Samai 100g 255 67 5.7 4.7 7.6

Small Onion 35g 17.5 3.885 0.42 0.0.35 0.21

Tomato 50g 17.5 3.35 0.75 0.1 2.1

Bengal gram 75g 180 45.675 12.875 3.95 2.925

dhal

Curry Leaf 15g 9.54 0.68 1.11 0.16 2.52

Varagu 50 g 165.8 33.1 4.46 1.27 3.2

Rice 100g 356.3 78.2 7.94 0.52 2.81

Califlower 50g 11.4 1.01 1.08 0.22 1.86

Brinjal 50g 25.3 3.5 1.48 0.3 3.98

Curd 30ml 18 0.9 0.93 1.2 -

Rice flakes 30g 106.1 23.00 2.23 0.34 1.04

Uradhal 30g 97.2 15.3 6.92 0.51 3.58

Carrot 30 g 14.4 3.18 0.27 0.66 0.36

Beet root 75 32.3 6.6 1.275 0.075 0.675

Ladies Finger 70 24.5 4.48 1.33 0.14 0.84

Red Chilli 10 24.6 3.16 1.59 0.62 3.02

Tumaric 10 28.97 6.74 0.29 - 0.53

Powder
Mustad seed 5 25.4 0.84 0.98 2.01 0.71

Skimmed Milk 100ml 34 4.8 3.37 0.08 -

Total 1851.45 349.39 71.74 21.046 24.295

Conclusion:

The patient named Mr.Karthikeyan .S aged 63 years was admitted in the hospital for

the complaint of Pedal Edama diagnosed in the hospital Pedal Edama and CKD

medication along with the diet given for the patient is soft diet prescribed in the

hospital and supervised regularly, The treatment helped the patient for fast recovery .