(a) Briefly describe the role of lifestyle interventions in prevention of coronary artery disease. 10 (b) Discuss the role of…

Lifestyle interventions in CAD prevention. Lifestyle modification is the first-line strategy in primary and secondary prevention of coronary artery disease because it modifies the major metabolic and inflammatory drivers of atherosclerosis. Smoking cessation is the single most important intervention, as tobacco use accelerates endothelial injury, thrombosis and plaque instability; counselling, nicotine replacement or pharmacotherapy should be offered. Diet should follow DASH or Mediterranean patterns, emphasising fruits, vegetables, whole grains, legumes, fish and unsaturated fats while limiting saturated fat, trans fat, salt and refined carbohydrates. Physical activity of at least 150 minutes per week of moderate-intensity exercise improves lipid profile, blood pressure, insulin sensitivity and weight. Weight management, aiming for BMI below 25 kg/m², reduces central adiposity and metabolic syndrome. Stress reduction through sleep, relaxation and psychosocial support lowers sympathetic and inflammatory burden. Finally, lifestyle measures must be combined with control of diabetes and hypertension, because sustained glycaemic and blood-pressure control prevents progression from subclinical atherosclerosis to clinical coronary events.

Imaging in pyelonephritis. Imaging is used to confirm diagnosis, detect complications and assess chronic scarring. Contrast-enhanced CT is the gold standard for acute pyelonephritis; it shows striated nephrogram, wedge-shaped hypodensities, perinephric fat stranding, abscess and obstruction, and is especially useful when diagnosis is uncertain or complications are suspected. Ultrasound is often the first-line investigation, particularly in children and pregnancy; it may show an enlarged kidney, altered echogenicity, perinephric fluid and, with power Doppler, perfusion defects. It is less sensitive than CT for early parenchymal changes but is safe and widely available. DMSA scan is the gold standard for detecting chronic renal scarring; it shows cortical defects and reduced uptake, and is useful after acute infection to identify children at risk of hypertension or renal impairment. IVU or CT urography is reserved for evaluating complications such as obstruction, vesicoureteral reflux, abscess or non-functioning segments, and for planning surgical or interventional management. Together, these modalities allow a stepwise approach from initial bedside assessment to definitive complication work-up.

WHO ARI pneumonia criteria and treatment. Under the WHO Acute Respiratory Infection Control Programme, children are assessed for cough or difficult breathing and classified by fast breathing, lower chest wall indrawing, stridor and general danger signs. Fast breathing is defined as respiratory rate more than 50/min in children 2–12 months and more than 40/min in children 1–5 years. Lower chest wall indrawing indicates severe pneumonia; it is diagnosed when cough or difficult breathing is accompanied by lower chest wall indrawing, and fast breathing is not required. Stridor in a calm child and danger signs such as inability to drink, convulsions, lethargy or unconsciousness indicate very severe disease and require urgent referral. A child with cough or difficult breathing but no fast breathing or chest indrawing has no pneumonia and receives home care. A child with fast breathing has pneumonia and should be treated with oral cotrimoxazole as the first-line ARI programme antibiotic, with home care and return precautions. Severe pneumonia requires hospitalization, oxygen if hypoxic, parenteral antibiotics and close monitoring. Very severe pneumonia requires urgent referral, oxygen, intravenous antibiotics and supportive care. This classification keeps management simple, scalable and focused on early recognition of children who need referral.

Hypothermia in SAM. In a 3-year-old child with severe acute malnutrition, hypothermia is a medical emergency because it worsens hypoglycaemia, infection and mortality. The child should be moved to a warming room maintained at 32–34°C, wet or cold clothing removed, and the body dried and covered, especially the head. Skin-to-skin contact or kangaroo mother care with the mother or caregiver is the most effective warming method and should be continued for at least several hours or until stable. The child must be fed immediately in small, frequent volumes if able to feed; if the child is lethargic, unable to feed, or hypoglycaemic, intravenous 10% glucose should be given because of aspiration risk and severity. Warm intravenous fluids may be given if needed for shock or dehydration, but overhydration must be avoided. Temperature, glucose, feeding tolerance and vital signs should be monitored continuously. Prevention in SAM children depends on maintaining a warm ambient environment, immediate and frequent feeding to prevent fasting hypoglycaemia, covering the head, avoiding unnecessary bathing, keeping the child dry and away from drafts, using appropriate clothing and blankets, and continuous temperature monitoring. These measures are especially important during the stabilization phase of SAM management.

Scabies in a joint family. The organism is Sarcoptes scabiei var. hominis. Transmission in a family occurs through prolonged close skin-to-skin contact, sharing of bedding, clothing and towels, and contact with asymptomatic carriers; crowding and close household living increase spread. Treatment must be simultaneous for all household members, including senior citizens, antenatal women and the one-month-old infant, even if some are asymptomatic. For the one-month-old infant, precipitated sulfur 5% ointment is preferred because topical permethrin 5% is not the approved first-line option for infants under 2 months; it should be applied to the whole body, including scalp, palms, soles and nails, and repeated after one week. For the antenatal woman, topical permethrin 5% is generally considered acceptable in pregnancy, or precipitated sulfur 5% can be used if preferred; oral ivermectin should be avoided in pregnancy. For senior citizens and other household members weighing 15 kg or more, permethrin 5% cream applied neck-down and washed off after 8–14 hours, repeated after one week, is appropriate; alternatively, oral ivermectin 200 mcg/kg can be given as a single dose and repeated after two weeks if needed, but it is contraindicated in children weighing less than 15 kg. Secondary bacterial infection should be treated with appropriate topical or oral antibiotics. Clothes, bedding and towels should be washed at 60°C or dry-cleaned, items that cannot be washed should be sealed for 72 hours, and the environment should be cleaned. Itching may persist for some weeks after successful treatment. Thus, effective management requires preventive lifestyle care, rational imaging, protocol-based ARI and SAM care, and household-wide scabies control.