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Dr K K Aggarwal

A small difference in blood pressure readings between arms is normal. However, a difference of more than 20 mmHg for systolic pressure (top number) or more than 10 mmHg for diastolic pressure (bottom number) can be a sign of an underlying narrowing of the main arteries to that arm.

A difference of 10 to 15 mmHg for upper systolic pressure that shows up repeatedly is a risk marker for vascular disease and future heart attacks.

Always have your doctor check blood pressure in both your arms and use that arm, with higher reading, for future blood pressure readings.

All about Diabetes

By Dr K K Aggarwal
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  • India is the diabetes capital of the world.
  • People with diabetes are nearly two times more likely than people without diabetes to die from heart disease, and are also at greater risk for kidney, eye and nerve diseases, among other painful and costly complications.
  • Type 2 diabetes can be delayed or prevented, and both types 1 and 2 diabetes can be managed to prevent complications.
  • In type 1 diabetes, the body does not make insulin. In type 2 diabetes, the body makes insufficient insulin or does not use insulin well.
  • Gestational diabetes occurs in some women during pregnancy. Though it usually goes away after the birth, these women and their children have a greater chance of getting type 2 diabetes later in life.
  • Type 2 diabetes has begun to affect young people.
  • Losing a modest amount of weight — about 15 pounds — through diet and exercise can actually reduce your risk of getting type 2 diabetes by as much as 58 percent in people at high risk.
  • In type 1 diabetes, tight control of blood sugar can prevent diabetes complications.
  • Choose healthy foods.
  • Take a brisk walk every day.
  • Talk with your family about your health and your family’s risk of diabetes and heart disease.
  • If you smoke, seek help to quit.
  • Make changes to reduce your risk for diabetes and its complications — for yourself, your families and for future generations.

When we gain weight, we must acquire more strength and when we lose weight, we must lose the strength. This is a fundamental principle.

If we gain weight and feel weak, it is a disease and when we lose weight and gain strength, we are recovering from the disease. One should not gain more than 5kg of weight after the age of 20 years. Any weight gain after that will only be due to accumulation of fat, which leads to insulin resistance.

Insulin resistance does not allow food to convert into energy. In the state of insulin resistance, whatever you eat is converted into fat. As it is not converted into energy, you feel weak. When you reduce insulin resistance by drugs or walking, the metabolism becomes normal and whatever you eat gets converted into energy and you start gaining strength.

All about depression

By Dr K K Aggarwal
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  • Depression is a major public health problem and a leading predictor of functional disability and mortality.
  • Optimal depression treatment improves outcome for most patients.
  • Most adults with clinical significant depression never see a mental health professional but they often see a primary care physician.
  • A non-psychiatric physician 50% of times misses the diagnosis of depression.
  • All depressed patients must be enquired specifically about suicidal ideations.
  • Suicidal ideation is a medical emergency.
  • Risk factors for suicide are known psychiatric disorders, medical illness, prior history of suicidal attempts or family history of attempted suicide.
  • The demographic reasons include older age, male gender, marital status (widowed or separated) and living alone.
  • About 1 million people commit suicide every year globally.
  • Around 79% of patients who commit suicide contact their primary care provider in the last one year before their death and only one-third contact their mental health service provider.
  • Twice as many suicidal victims had contacted their primary care provider as against the mental health provider in the last month before suicide.
  • Suicide is the 10th leading cause of death worldwide and accounts for 1.2% of all deaths.
  • The suicide rate in the US is 10.5 per 100,000 people.
  • In the US, suicide is increasing in middle aged adults.
  • There are 10-40 non-fatal suicide attempts for every one completed suicide.
  • The majority of suicides completed in US are accomplished with fire arm (57%), the second leading method of suicide in US is hanging for men and poisoning in women.
  • Patients with prior history of attempted suicide are 5-6 times more likely to make another attempt.
  • Fifty percent of successful victims have made prior attempts.
  • One of every 100 suicidal attempt survivors will die by suicide within one year of the first attempt.
  • The risk of suicide increases with increase in age; however, young adults and adolescents attempt suicide more than the older.
  • Females attempt suicide more frequently than males but males are successful three times more often.
  • The highest suicidal rate is amongst those individuals who are unmarried followed by those who are widowed, separated, divorced, married without children and married with children in descending order.
  • Living alone increases the risk of suicide.
  • Unemployed and unskilled patients are at higher risk of suicide than those who are employed.
  • A recent sense of failure may lead to higher risk.
  • Clinicians are at higher risk of suicide.
  • The suicidal rate in male clinicians is 1.41 and in female clinicians, it is 2.27.
  • Adverse childhood abuse and adverse childhood experiences increase the risk of suicidal attempts.
  • The first step in evaluating suicidal risk is to determine presence of suicidal thoughts including their concerns and duration.
  • Management of suicidal individual includes reducing mortality risk, underlying factors and monitoring and follow-up.
  • Major risk for suicidal attempts is in psychiatric disorder, hopelessness and prior suicidal attempts or threats.
  • High impulsivity or alcohol or other substance abuse increase the risk.

Donating blood reduces chances of heart attack

By Dr K K Aggarwal
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One should donate blood at least once in a year. Donating blood regularly has been shown in many reports to reduce chances of future heart attacks. Blood donation is also one of the best charities that one can do as it can save multiple lives through various components taken out of a single blood transfusion.

All those who are going for elective surgery should donate their blood well in advance and the same should be used at the time of surgery.

In the current medical tourism scenario, many patients who are Jehovah’s Witnesses refuse blood transfusion on religious grounds. They do not accept transfusion of whole blood or any of the four major components (blood cells, platelets, plasma and white cells). They are prepared to die rather than receive the blood. They also do not accept transfusion of stored blood including their own due to the belief that blood should not be taken out of the body and stored for any length of time. In such cases, every effort should be made to reduce blood loss, conserve blood and give drugs that can enhance hemoglobin formation.

A new concept called Bloodless Medicine has now become a reality where treatment, surgery and even emergency surgery can be done without using any blood.

Tips to prevent Dengue and Malaria

By Dr K K Aggarwal
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  • Both malaria and dengue mosquitoes bite during day time.
  • It is the female mosquito which bites.
  • Dengue mosquito takes three meals in a day while malaria mosquito takes one meal in three days.
  • Malaria may infect only one person in the family but dengue will invariably infect multiple members in the family in the same day.
  • Malaria fever often presents with chills and rigors. Suspect Chikungunya if the fever presents together with joint and muscle pains.
  • Both dengue and malaria mosquitoes grow in fresh water collected in the house.
  • The filaria mosquito grows in dirty water.
  • There should be no collections of water inside the house for more than a week.
  • Mosquito cycle takes 7-12 days to complete. So, if any utensil or container that stores water is scrubbed cleaned properly once in a week, there are no chances of mosquito breeding.
  • Mosquitoes can lay eggs in flower pots or in water tanks on the terrace if they are not properly covered.
  • If the water pots for birds kept on terraces are not cleaned every week, then mosquitoes can lay eggs in them.
  • Some mosquitoes can lay eggs in broken tires, broken glasses or any container where water can stay for a week.
  • Using mosquito nets/repellents in the night may not prevent malaria and dengue because these mosquitoes bite during the day time.
  • Wearing full sleeves shirt and trousers can prevent mosquito bites.
  • Mosquito repellent can be of help.
  • If you suspect that you have a fever, which can be malaria or dengue, immediately report to the doctor.

Some facts on noise levels

By Dr K K Aggarwal
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  • Continuous exposure to sounds above 85 db can cause progressive hearing loss. Anyone exposed to sounds above 85 db of noise requires hearing protection.
  • The special limit for people who are exposed to noise above 90 db is 8 hours, for 95 db is 4 hours and 2 hours for 100 db.
  • A short blast of loud sound also can cause severe to profound sensory neural hearing loss and pain. This usually involves exposure to noise above 120-155 db. Hearing protection in the form of muffins or ear plugs is highly recommended anytime a person is exposed to loud noise.

Tips to prevent water-borne diseases this monsoon:

By Dr K K Aggarwal
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  • Drink only filtered/boiled water.
  • Store water in a clean container.
  • Water jars/containers should be washed daily.
  • Always wash hands before and after preparing food and eating. Likewise, children should be educated about the importance of washing their hands effectively and regularly.
  • It is mandatory to wash one’s hands with soaps or use hand sanitizers after using a washroom, changing a childs diaper, or after visiting unclean and infection-prone areas, such as public washrooms, hospitals, etc.
  • Consume warm and home cooked foods and avoid consuming street food.
  • Wash food thoroughly before cooking.
  • Always keep foods/beverages covered.
  • Make sure that the pipes and tanks that supply water to your house are properly maintained and clean.
  • Travelers should only drink bottled water and avoid uncooked food.
  • People suffering from water-borne diseases should not go to work until fully recovered to avoid spreading the infection.
  • Avoid using ice made from tap water.
  • Freezing does not kill the organisms that cause diarrhea. Ice in drinks is not safe unless it has been made from adequately boiled or filtered water.
  • Alcohol does not sterilize water or the ice. Mixed drinks may still be contaminated.
  • Hot tea and coffee are the best alternates to boiled water.
  • Drink only filtered/boiled water.
  • Store water in a clean container.
  • Water jars/containers should be washed daily.
  • Always wash hands before and after preparing food and eating. Likewise, children should be educated about the importance of washing their hands effectively and regularly.
  • It is mandatory to wash one’s hands with soaps or use hand sanitizers after using a washroom, changing a childs diaper, or after visiting unclean and infection-prone areas, such as public washrooms, hospitals, etc.
  • Consume warm and home cooked foods and avoid consuming street food.
  • Wash food thoroughly before cooking.
  • Always keep foods/beverages covered.
  • Make sure that the pipes and tanks that supply water to your house are properly maintained and clean.
  • Travelers should only drink bottled water and avoid uncooked food.
  • People suffering from water-borne diseases should not go to work until fully recovered to avoid spreading the infection.
  • Avoid using ice made from tap water.
  • Freezing does not kill the organisms that cause diarrhea. Ice in drinks is not safe unless it has been made from adequately boiled or filtered water.
  • Alcohol does not sterilize water or the ice. Mixed drinks may still be contaminated.
  • Hot tea and coffee are the best alternates to boiled water.

All about tea

By Dr K K Aggarwal
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When we speak of tea, it is commonly assumed to be black tea with milk and sugar. However, the word ‘Tea’ means any herb. This means even hot Tulsi water is Tulsi tea or hot mint water is Mint tea. Many herbs can be converted into tea such as jasmine tea, lemon tea, lemon grass tea, masala tea, sounf tea, etc.

When the decoction of the leaves and the water is reduced to 50% on boiling, it is called Kadha. Black tea without milk and sugar is much healthier than black tea with milk and sugar.

Classical tea without sugar and milk has an astringent taste. But according to Ayurveda, this is good for health as it reduces Kapha imbalance. When sugar and milk are added, both of which have sweet taste, they neutralize the weight reducing and kapha-relieving properties of the black tea. Therefore, milk or sugar should not be added to tea. For the purpose of taste, one can add Gur or jaggery or artificial plant sweetener Stevia.

Black tea is also a mild diuretic and increases urination as it contains caffeine, which is also a stimulant. This is the reason why tea is used to remain awake. In this regard, coffee is stronger than tea. When taken in moderation, black tea is good for the heart and general health. If one has to choose a tea, then jasmine, lemon and lemongrass teas are better.

In Ayurveda, different teas have been prescribed for different personalities. Therefore, you can get vata–pacifying tea, pitta–pacifying tea and kapha–pacifying tea.

Most uncontrolled asthmatics think they are controlled

By Dr K K Aggarwal
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Two-thirds of patients with uncontrolled asthma think their disease is well under control. Asthmatics on proper medicines can not only live a normal life but also reduce their future complications.

Uncontrolled asthmatics invariably end up with right heart complications due to persistent lack of oxygenation in the blood.

Dr. Eric van Ganse, of University of Lyon, France, in a study published in the Annals of Allergy, Asthma, and Immunology, examined 1,048 subjects with inadequate asthma control. When asked how they would rate their asthma control over the past 14 days, over 69% considered themselves to be completely or well controlled. Failure to perceive inadequate asthma control was more likely to be found in patients between the ages of 41 and 50 years.

The reasons are:

  • Most asthmatics fail to perceive their level of disease control and with an uncontrolled state they often feel that their asthma is under control.
  • In severe asthma, low blood oxygen levels might impair a person’s ability to assess their own breathing difficulty.
  • The notion of asthma control seems poorly understood by asthmatic patients.

Mild to moderate asthma limits the activities of a person and they, over a period of time, take that as their normal limits.

Most uncontrolled asthmatics think they are controlled

By Dr K K Aggarwal
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Two-thirds of patients with uncontrolled asthma think their disease is well under control. Asthmatics on proper medicines can not only live a normal life but also reduce their future complications.

Uncontrolled asthmatics invariably end up with right heart complications due to persistent lack of oxygenation in the blood.

Dr. Eric van Ganse, of University of Lyon, France, in a study published in the Annals of Allergy, Asthma, and Immunology, examined 1,048 subjects with inadequate asthma control. When asked how they would rate their asthma control over the past 14 days, over 69% considered themselves to be completely or well controlled. Failure to perceive inadequate asthma control was more likely to be found in patients between the ages of 41 and 50 years.

The reasons are:

  • Most asthmatics fail to perceive their level of disease control and with an uncontrolled state they often feel that their asthma is under control.
  • In severe asthma, low blood oxygen levels might impair a person’s ability to assess their own breathing difficulty.
  • The notion of asthma control seems poorly understood by asthmatic patients.

Mild to moderate asthma limits the activities of a person and they, over a period of time, take that as their normal limits.

Hepatitis B is a more dangerous infection than HIV

By Dr K K Aggarwal
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  • Viral hepatitis and HIV coinfection is a common problem and challenge to the treating clinician.
  • People with HIV who are coinfected with hepatitis B virus (HBV) or hepatitis C virus (HCV) are at increased risk for serious, life-threatening health complications.
  • All people living with HIV should be tested for hepatitis B and C infections.
  • HIV and viral hepatitis coinfection can complicate the management of HIV infection.
  • Progression of liver disease is faster in individuals with HIV and viral hepatitis coinfection; also, they may not respond as well to treatment.
  • Hepatitis B is preventable; hepatitis B vaccination is recommended for high-risk people or those living with HIV who have tested negative for HBV.
  • Give hepatitis B vaccine to all unvaccinated persons after exposure to blood. If the blood is positive for HBV and the exposed person is unvaccinated, treatment with hepatitis B immune globulin is recommended.
  • HIV, HBV and HCV have similar routes of transmission. They spread by contact with infected body fluids such as blood, semen and vaginal fluid, or from a mother to her baby during pregnancy or delivery. Because of these shared routes of transmission, people at risk for HIV infection are also at risk for HBV or HCV infection. Of these, hepatitis B is more infectious.
  • Hepatitis B virus gets transmitted by percutaneous and mucosal exposures and human bites.
  • Hepatitis B can also be transmitted by fomites such as finger stick blood sugar check, multidose medication vials, jet gun injectors, and endoscopes. Hepatitis B virus can survive on counter tops for up to 7 daysand remain capable of causing infection.
  • Any scratch, cut and wound should be cleaned with soap and water and covered with a waterproof dressing or plaster. Expressing fluid by squeezing the wound will not reduce the risk of blood borne infection.
  • Blood spills from someone with hepatitis B should be cleaned up with appropriate infection control procedures, e.g. wearing gloves, and using an appropriate cleaning product for the surface, such as diluted bleach or detergent and warm water.
  • Transmission of hepatitis C virus can occur from infected fluid splashes to the conjunctiva. Hepatitis C virus can survive on environmental surfaces for up to 16 hours.

Normal Aging Changes

By Dr K K Aggarwal
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  • Heart rate shows less variability.
  • There is altered circadian pattern (24-hour cycle of the body).
  • There is a delayed response of bone marrow to loss of blood or hypoxia (reduced oxygen).
  • The function of the white blood cells is impaired.
  • Advancing age is a procoagulant stage. This means that the blood gets clotted easily.
  • Reflux of the stomach acid in the food pipe is common.
  • Tendency to constipation is common.
  • Painkillers can quite easily cause ulcers in the stomach.
  • Renal functions decline with age.
  • Older kidney is more prone to be damaged with painkillers.
  • Calcification of heart valves may occur.
  • The maximum heart rate may not reach the level as that in young age in response to exercise.
  • About one-third of the lung volume may be lost.
  • Aging slows the rate of fracture repair.
  • Skin may become atrophic (thin) and elasticity is reduced.
  • A person may not be able to read small print.
  • There may be impaired speech recognition in noisy environment.
  • There may be loss of taste.
  • There may be loss of smell.
  • There may be high frequency hearing loss.
  • Immunity may be reduced.
  • With age, one is more prone to get urinary tract infection.
  • With age, ejaculation may get impaired.

Biomedical Waste: Handle With Care

By Dr K K Aggarwal
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Reproduced from: http://www.indialegallive.com/health/biomedical-waste-handle-with-care-67977, published June 30, 2019

A judge has pulled up hospitals and healthcare facilities in Noida, Greater Noida and Ghaziabad for causing 40 percent of recurrent infections in patients by not scientifically disposing of waste

Healthcare waste is dangerous and infectious. As per the UP Solid Waste Management Monitoring Committee, hospitals and healthcare facilities in Noida, Greater Noida and Ghaziabad are responsible for 40 percent of recurrent infections in patients as they don’t adhere to scientific disposal of biomedical waste through segregation.

Healthcare waste includes all waste generated by healthcare establishments, research facilities and laboratories. In addition, it includes the waste originating from “minor” or “scattered” sources such as that produced in homes (dialysis, insulin injections, etc). Between 75 to 90 percent of the waste produced by healthcare providers is non-risk or “general” waste, comparable to domestic waste. It comes mostly from the administrative and housekeeping functions of healthcare establishments and may include waste generated during the maintenance of these premises. The remaining 10-25 percent of healthcare waste is regarded as hazardous and may create a variety of health risks.

Hazardous healthcare waste (also known as healthcare risk waste) needs special regulation, but general wastes can be dealt with by municipal waste disposal mechanisms. There are different categories of healthcare waste.

  • Infectious waste: Waste suspected to contain pathogens such as laboratory cultures, waste from isolation wards, tissues (swabs), materials, or equipment that have been in contact with infected patients, excreta.
  • Pathological waste: Human tissues, blood and other body fluids, foetuses.
  • Sharps: Sharp waste such as needles, infusion sets, scalpels, knives, blades, broken glass.
  • Pharmaceutical waste: Waste containing pharmaceuticals that have expired or are no longer needed, items contaminated by or containing pharmaceuticals (bottles, boxes).
  • Genotoxic waste: Waste containing cytostatic drugs (often used in cancer therapy), genotoxic chemicals.
  • Chemical waste: Waste containing laboratory reagents, film developers, disinfectants that are expired or no longer needed.
  • Solvents: Wastes with high content of batteries, broken thermometers, blood-pressure gauges, heavy metals.
  • Pressurised containers: Gas cylinders, gas cartridges, aerosol cans.
  • Radioactive waste: Waste containing radioactive substances such as unused liquids from radiotherapy or laboratory research, contaminated glassware, packages or absorbent paper; urine and excreta from patients treated or tested with unsealed radionuclides.

Justice DP Singh, the chairman of the Committee, said that hospitals and healthcare facilities across Noida, Greater Noida and Ghaziabad are making a mockery of biomedical waste handling rules by dumping medical waste with municipal garbage. “I have data from an international source that says about 35-40 percent of the recurrent infections occur from hospitals and medical centres due to such negligence of non-segregated waste,” he said. He has fixed June 30 as the deadline for covering of all open dump sites and segregation of waste at public places, including biomedical waste, in Noida and Ghaziabad.

This directive is important as infectious waste often contains pathogens (bacteria, viruses, parasites or fungi) in sufficient concentration or quantity to cause disease in susceptible hosts. This category includes:

  • Cultures and stocks of infectious agents from laboratories.
  • Waste from surgery and autopsies on patients with infectious diseases (e.g. tissues, and materials or equipment that have been in contact with blood or other body fluids).
  • Waste from infected patients in isolation wards.
  • Waste that has been in contact with infected patients undergoing haemodialysis (e.g. dialysis equipment such as tubing and filters, disposable towels, gowns, aprons, gloves and laboratory coats).
  • Infected animals from laboratories.
  • Any other instruments or materials that have been in contact with infected persons or animals.

On March 19, the government published in the e-gazette, the Bio-Medical Waste Management (Amendment) Rules, 2019. The key points of the amended rules are as follows:

  • The occupier of all bedded healthcare units shall maintain and update on a day-to-day basis the biomedical waste management register.
  • All bedded healthcare units shall display the monthly record of waste disposal management on their websites.
  • Such healthcare facilities (irrespective of any number of beds) shall make the annual report available on their websites before March 19, 2021.
  • Healthcare facilities having less than 10 beds shall have to comply with the output discharge standard for liquid waste by December 31, 2019.

In addition, the Indian Penal Code (IPC) too has various sections dealing with such waste. Section 269, IPC, says: “Negligent act likely to spread infection of disease dangerous to life—Whoever unlawfully or negligently does any act which is, and which he knows or has reason to believe to be likely to spread the infection of any disease dangerous to life, shall be punished with imprisonment of either description for a term which may extend to six months, or with fine, or with both.”

Section 270 deals with a “Malignant act likely to spread infection of disease dangerous to life—Whoever malignantly does any act which is, and which he knows or has reason to believe to be, likely to spread the infection of any disease dangerous to life, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both.”

There are other carriers of infections too. According to a new study in the Emergency Medicine Journal, December 1, 2018, oxygen cylinders act as carriers for a bacterium called methicillin-resistant staphylococcus aureus (MRSA). In the study, researchers tested the surface of nine oxygen cylinders and regulators in ambulances at an emergency medical services station in North Alabama, US, while 70 offsite oxygen cylinders were also tested. Of the nine oxygen cylinders tested in ambulances, all had MRSA colonisation (100 percent). MRSA was also present on 67 of 70 oxygen cylinders (96 percent) tested at the offsite oxygen cylinder storage area.

Last year, a study reported in the September 2018 issue of American Journal of Infection Control found that patient privacy curtains surrounding beds in hospitals become progressively contaminated with bacteria, including MRSA. The increased MRSA positivity was observed between 10 to 14 days after the curtains are hung. By the 14th day, seven (87.5 percent) of the eight tested curtains were positive for MRSA. This was the time to either change or clean the curtains, suggested the study.

A new study published online on December 12, 2018, in the Infection Control and Hospital Epidemiology reported stethoscopes as carriers of infection. Out of 40 stethoscopes in use in an ICU, all had a high abundance of staphylococcus bacteria, with “definitive” S aureus bacteria present on 24 of 40 stethoscopes tested.

The British Medical Journal reported in 2015 that white coats worn by doctors harbour potential contaminants and contribute considerably to the burden of disease acquired in hospital by spreading infection. Research has also shown an association of yoga mats with fungal, bacterial and viral infections.

In addition to healthcare waste, equipment handles, clothes, carpets, etc, are also sources of bacteria. Computers, telephones, telephone mouthpieces, headsets, desks, ATMs, cash machines and elevator buttons have also been reported as potential sources for transmitting infectious microorganisms. Notes and coins are also a source of infection. Bank notes recovered from hospitals may be highly contaminated by staphylococcus aureus, while salmonella, Escherichia coli and S aureus are commonly isolated from bank notes from food outlets. Influenza virus, norovirus, rhinovirus, hepatitis A virus and rotavirus can be transmitted through hand contact.

This new study only adds to the growing list of evidence that for all practical purposes, everything used in healthcare can be considered to be contaminated and a potential source of cross-contamination in hospitals. While hand to hand transmission of microbes remains an important route of spread of infection, these studies highlight the role of contaminated environmental surfaces in the transmission of healthcare-associated infections.

The one way to prevent the spread is proper biomedical waste disposal and adoption of universal precautions.

Every surface in a healthcare setting needs to be assumed infected unless proven otherwise.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Preventing heat disorders

By Dr K K Aggarwal
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During summer, susceptible children and adolescents can develop heat stroke, which can even lead to death if not identified and treated in time.

  • Heat index is more important than the atmospheric temperature. A 42 degree temperature may feel like 46 degrees if the heat index is high.
  • Avoid prolonged exposure to sun when the temperature is high. Use an umbrella if you need to go out.
  • Wear light cotton clothes to avoid heat absorption.
  • Make sure that you are properly hydrated before you step out in the heat. The requirement of water in summer is 500 ml more than that in winter.
  • Summer drinks should be refreshing and cool such as panna, khas khas, rose petal water, lemon water, bel sharbat and sattu sharbat.
  • Any drink with more than 10% sugar becomes a soft drink and so should be avoided. Ideally, the percentage of sugar, jaggery or khand should be 3%, which is the percentage present in oral rehydration drink.
  • You should pass urine at least once in 8 hours. This is a sign of adequate hydration.
  • If you develop heat cramps, drink plenty of lemon water with sugar and salt.
  • Heat exertion presents with fever and sweating. If you develop heat exertion, drink plenty of oral fluids, mixed with water, lemon and sugar. Presence of sweating is good sign.
  • If a person develops high grade fever, i.e. more than 104 degrees Fahrenheit with dry armpits, this is a sign of impending heat stroke, which is a medical emergency. The temperature here may be more than 106 degree Fahrenheit. Fever should be brought down rapidly within minutes to save the life.
  • People, who have been advised to restrict their fluid intake on medical grounds, should discuss their fluid requirement in summer with their doctor.