What’s new in Gynecology?

What’s new in Gynecology?

• Use of selective serotonin reuptake inhibitors (SSRIs) to treat pregnant patients does not appear to be associated with stillbirth or infant mortality (1).
• The United States Advisory Committee on Immunization Practices (ACIP) recommended that all pregnant women receive the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during each pregnancy, optimally between 27 and 36 weeks of gestation, regardless of prior vaccination status, to increase the likelihood of optimal protection against pertussis for both the mother and her infant during the first few months of the infant’s life (2). Previously, Tdap was recommended only for pregnant women who had not previously received the acellular pertussis vaccine during adulthood.
• Vaccination during pregnancy substantially reduced the risk of a maternal influenza diagnosis (adjusted hazard ratio, 0.30) and was associated with a trend in reduction of fetal death. All women who are pregnant or will be pregnant during influenza season should receive the inactivated influenza vaccine, regardless of pregnancy trimester (3).
• A December 2012 American College of Obstetricians and Gynecologists (ACOG) committee opinion concluded that the decision to perform early versus delayed cord clamping in term deliveries should be based on patient-specific factors, particularly the infant’s risk of developing iron deficiency anemia (4). For preterm deliveries, they recommended delayed cord clamping given the significant reduction in intraventricular hemorrhage associated with this intervention (3).
• In a prospective study of mothers who used benzodiazepines (primarily lorazepam, clonazepam, and midazolam) while breastfeeding, central nervous system depression (defined as sleepiness, poor latching, limpness, or lack of response to stimuli) in infants was an infrequent finding (affecting 2 out of 124, or 1.6 percent) (5).

References

1. Stephansson O, Kieler H, Haglund B, et al. Selective serotonin reuptake inhibitors during pregnancy and risk of stillbirth and infant mortality. JAMA 2013;309:48.

2. Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine (Tdap) in Pregnant Women — Advisory Committee on Immunization Practices (ACIP), 2012 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6207a4.htm?s_cid=mm6207a4_e (Accessed on February 21, 2013).

3. Håberg SE, Trogstad L, Gunnes N, et al. Risk of fetal death after pandemic influenza virus infection or vaccination. N Engl J Med 2013;368:333.

4. Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 2012;8:CD003248.

5. Kelly LE, Poon S, Madadi P, Koren G. Neonatal benzodiazepines exposure during breastfeeding. J Pediatr 2012;161:448.

The Vedic Will – as I understand it

The Vedic Will – as I understand it

Sometimes back, I used to think Will means after my death how my finances will be controlled by me wife and my children.

As I started acquiring Vedic knowledge, my interpretation changed. Following is the gist for writing a Will, as I understand it the Vedic way.

Of course, Will writing requires a sound state of mind, two witnesses, signed registered paper with accompanying, if possible audio-visual link.

1.   The first step is to calculate your life earnings. The earning is not only your finances earned but also your respect, dignity and image earned in the society.

2.   Now the next step is to pay off your unpaid debts (Hrins). Apart from actual loans we have taken from banks, friends and others, there are three more debts (Hrins) which we need to pay before we die and define in our Will to be paid from our earning if we die unexpectedly. These as per mythology are Pitra Hrin, Dev Hrin and Rishi Hrin. They means not been able to fulfill the committed desires of our ancestors and commitments made to our GOD and teachers respectively. All these debts, if unpaid, need to be paid out of the finances you are leaving at the time of death. A percentage of your finances, therefore, should be kept to pay these debts. These commitments are usually fulfilled by the eldest son and eldest daughter if there is no son or wife till she is alive.

3.    Rest of my finances need to be divided to fulfill your Dharma, Artha, Kama and Moksha or purpose for which you were born.

a.   Artha – a percentage of your finances should go and be equally divided within your immediate family. A percentage of this amount should be converted into a family trust account to be used for the minus 18 years of age children in future.

b.   Dharma: Dharma in literal meaning is to hold. A percentage of your finances should be kept into a reserve account and this account interest can be used by the family only if they stick to the code of family conduct (includes rituals, religious activities etc) you have created in your life and mentioned in the will or this amount may be given for charity as defined in your will.

c.    Kama and Moksha:Kama means the unfulfilled desires at the level of intellect and ego and Moksha the same at the level of our soul.

We must enlist both our desires at the level of mind and at the level of soul and a percentage of our finances should be converted into a trust or defined to fulfill these desires.

The examples of desires at the level of soul are to do some charitable work without any publicity. The same at the level of ego are to open some dispensary, Dharamshala etc. on our own name.

In your desires you also need to fulfill and document your desired rituals at the time of death.  These rituals must answer the following questions

i.  Should my death be celebrated (band, lunch) as I completed all my purposes of life?

ii.  How should my death anniversary be celebrated or observed?

iii.  What should be my last rites?

Final Note: If my children and wife are not willing to take care of the finances other than Artha, I nominate the following persons to manage my finance to look after my other desires (…………………………..).

Tips on family history of high cholesterol

Tips on family history of high cholesterol

Premature heart disease is when heart disease occurs before 55 years in men and 65 years in women. In premature heart disease, the prevalence of dyslipidemia (high cholesterol levels without symptoms) is 75-85%.

Fifty-four percent of all patients with premature heart disease and 70% of those with a lipid abnormality have a familial disorder. Hence, a screening test for lipids is recommended for first-degree relatives of patients with myocardial infarction, particularly if premature. Screening should begin with a standard lipid profile and if normal, further testing should be done for Lp(a) and apolipoproteins B and A-I.

About 25% patients with premature heart disease and a normal standard lipid profile will have an abnormality in Lp(a) or apo B. Elevated apo A-1 and HDL are likewise associated with reduced CHD risk.

First-degree relatives are brothers, sisters, father, mother; second-degree relatives refer to aunts, uncles, grandparents, nieces, or nephews and third-degree relatives refer to first cousins, siblings, or siblings of grandparents.

Familial hypercholesterolemia (FH) is a genetic disorder, characterized by high cholesterol, specifically very high LDL “bad cholesterol”) levels and premature heart disease. Patients may develop premature cardiovascular disease at the age of 30 to 40. Heterozygous FH is a common genetic disorder, occurring in 1:500 people in most countries. Homozygous FH is much rarer, occurring in 1 in a million births. Heterozygous FH is normally treated with drugs. Homozygous FH often does not respond to medical therapy and may require apheresis or liver transplant.

To detect familial high cholesterol levels, a universal screening must be done at age 16. The cholesterol levels in heterozygous patients are between 350 to 500 mg/dL, and in homozygous, the levels are between 700 to 1,200 mg/dL.

Every arthritis is not same

Every arthritis is not same

Every arthritis is not the same. While osteoarthritis, also called as green arthritis, may require only painkillers and rehabilitation exercises, the red inflammation arthritis called rheumatoid arthritis, if not treated early and aggressively can end up with serious deforming complications.

Any arthritis in young women of child-bearing age should not be ignored, especially if it is worse in the morning and improves by movement. Most of them will have high platelet count on blood examination. These patients require aggressive treatment with disease-modifying drugs within days of the onset of symptoms and diagnosis. Approximately 1-2% of population may have this type of disease.

Osteoarthritis, on the other hand, is a disease of age 50+ and is due to wear and tear of various joints in the body and break down of the cartilage cushion in the joints. It mainly affects the weight-bearing joints like the knees, hips, neck and lower back joints. Inflammation is not a major feature of osteoarthritis. The experts said that another form of joint disorder is due to gout which is never seen in people below 40 years of age and is almost never seen in young women before the onset of menopause unless there is a known underlying kidney disease and never seen in children.

The progression of osteoarthritis can be arrested with appropriate exercises, weight reduction and preventing posture and movement that worsen the disease.

Typical wear and tear of osteoarthritis is caused by sitting cross legged, doing Padmasana, squatting, other non physiological postures, sitting on low level surface like floor and low chairs, doing push ups, going up and down on stairs, etc.

Most yoga postures should be done under medical supervision and should follow with a counter yoga exercise.

Most patients of serious arthritis end up with treatment with other systems of medicines or with quacks.

Why do We Worship the Tulsi Plant?

Why do We Worship the Tulsi Plant?

Yanmule sarvatirhaani, Yannagre sarvadevataa, 

Yanmadhye sarvavedaascha,Tulasi taam namaamyaham

“I bow to the Tulsi, At whose base are all the holy places, At whose top reside all the deities and In whose middle are all the Vedas.”

The Tulsi or Sacred Basil is one of the most sacred plants. There is a Sanskrit: “Tulanaa naasti athaiva tulsi” that which is incomparable in its qualities is the tulsi. It is the only pooja samagri which can be washed and reused.

Satyabhama once weighed Lord Krishna against all her legendary wealth. The scales did not balance until a last single tulsi leaf was placed along with the wealth on the scale by Rukmini with devotion. Thus, tulsi played the vital role of demonstrating that even a small object offered with devotion is of greater value than all the wealth in the world.

The Tulsi leaf has great medicinal value and is used to cure various ailments, including the common cold. Tulsi seeds are good for male infertility and increase the viscosity of semen and sperm counts. It has detoxifying properties and is used in fasts including the Satynarayana Katha where a thousand tulsi leaves are added to the water for pooja, and which is consumed later by everybody.

Tulsi also symbolizes Goddess Lakshmi. Those who wish to be righteous and have a happy family life worship the tulsi. Tulsi is ‘married’ to Lord Vishnu with pomp and show like any other wedding. This ‘marriage’ is solemnised because according to a legend, the Lord blessed her to be His consort.  Tulsi is worshipped in the months of Magh and Kartik. Tulsi vivah is observed in the month of Kartik and is the symbolic marriage of Lord Vishnu in the form of a shaligram (sacred stone) and Tulsi. It indicates the importance of  Tulsi for fertility. Tulsi pooja is an important component of any marriage.

(Suggestion: give the English equivalent months for magh and kartik)

Why do We Ring the Bell in a Temple?

Why do We Ring the Bell in a Temple?

The vibrations of the ringing bell also produce the auspicious primordial sound ‘Om’, thus creating a connection between the deity and the mind. As we start the daily ritualistic worship (pooja), we ring the bell, chanting:

Aagamaarthamtu devaanaam

gamanaarthamtu rakshasaam

Kurve ghantaaravam tatra

devataahvaahna lakshanam

“I ring this bell indicating the invocation of divinity, So that virtuous and noble forces enter (my home and heart); And the demonic and evil forces From within and without, depart.”

Reduce liquids to reduce weight

Reduce liquids to reduce weight

When it comes to losing weight, cut down on liquid calories rather than food,.

“Weight loss from liquid calories is greater than loss of calorie intake from solid food, as per Dr. Liwei Chen, an assistant professor of epidemiology at the Schoolof Public Healthat the LSU Health Science Center in New Orleans, in the American Journal of Clinical Nutrition.

Body is able to self-regulate its intake of solid food. If you eat too much solid food at lunch, you’ll tend to eat less at dinner. But the same self-regulation is not in place for what you drink. The body does not adjust to liquid calories, so over time, you gain more weight.

Cutting back on calories from sugary drinks – by only one serving per day – can account for nearly two-and-a-half pounds of lost weight over 18 months.

Beverages are categorized into eight categories

1. Sugar-sweetened beverages (including soft drinks, fruit drinks, fruit punch, or high-calorie beverages sweetened with sugar)

2. Diet drinks such as diet soda and other diet drinks that were artificially sweetened

3.       Milk (including whole milk, 2 percent milk, and 1 percent skim)

4.       100 percent fruit and vegetable juice

5.       Coffee and tea with sugar

6.       Coffee and tea without sugar

7.       Alcoholic beverages

8.       Water with no calories

The best drinks are water, plain soda and tea/coffee with no sugar.