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Dr K K Aggarwal

Give BP drugs at night

By Dr K K Aggarwal
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Blood pressure drugs should be taken at night. Uncontrolled blood pressure can lead to heart attacks, paralysis and heart failure. Most such attacks occur in the early morning hours. Pulse, blood pressure and thickening of platelets are all higher in the early morning hours. Controlling early morning blood pressure can reduce cardiovascular mortality. According to a study published in the Journal of the American Society of Nephrology, among patients with chronic kidney disease (CKD) and high blood pressure, taking at least one antihypertensive drug at bedtime significantly improves blood pressure control, with an associated decrease in risk for cardiovascular events. The study included 661 patients with CKD, who were randomly assigned either to take all prescribed anti-BP drugs on awakening or to take at least one of them at bedtime. Patients were followed for a median of 5.4 years; during that time, patients who took at least one BP-lowering drug at bedtime had approximately one-third of the cardiac risk than those who took all medications on awakening. A similar significant reduction in cardiac deaths, heart attacks and paralysis was noted with bedtime dosing. Patients taking their medications at bedtime also had a significantly lower mean BP while sleeping. For each 5 mmHg decrease in mean sleep-time systolic upper BP, there was a 14% reduction in the risk for cardiovascular events during follow-up. Potential explanation for the benefit of night time treatment may be associated with the effect of night time treatment on urinary albumin excretion levels. Urinary albumin excretion is significantly reduced after bedtime, but not morning, treatment.

Treatment of acute leg cramps

By Dr K K Aggarwal
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Patients with an acute leg cramp should forcefully stretch the affected muscle, as an example by active dorsiflexion of the foot with the knee extended, when the cramp is in the calf.

Some patients may also find relief from passive stretching by getting out of bed and standing with the foot flat on the floor then pressing downward firmly, although active dorsiflexion of the foot may be more effective.

Other measures that may offer relief from the acute cramp include:

  • Walking or leg jiggling followed by leg elevation
  • A hot shower with the stream directed at the cramp area of the body, usually for five minutes, or a warm tub bath
  • Ice massage

Treatment of fatty liver

By Dr K K Aggarwal
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  1. A 10% weight loss can improve fatty liver and possibly inflammation.
  2. Metformin and ursodeoxycholic acid (UDCA) are not recommended.
  3. Statins are safe in patients with fatty liver but whether they can reduce fatty liver is not known.
  4. Omega-3 fatty acids have been tried.
  5. Pioglitazone is useful in the treatment of biopsy-proven fatty liver with inflammation.
  6. Vitamin E at a dose of 800 IU/day improves liver inflammation
  7. Use of bariatric surgery for treatment of fatty liver is premature and should be avoided in patients with cirrhosis.

Treatment of Summer Diarrhea

By Dr K K Aggarwal
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The main complication is renal shut down, which will happen if the blood pressure remains low for more than few hours. During loose motions, one should maintain that he or she passes urine every 6-8 hours. If no urine is passed for eight hours it may indicate an impending renal failure.One loose motion is equal to one glass of ORS. Most summer diarrhea is watery, effortless and painless diarrhea with no mucous or blood. No antibiotic is needed. The only treatment is oral rehydration solution. 
One loose motion is equivalent to loss of one glass of fluid. If a patient has passed 10 loose motions, he needs 12 glasses of ORS apart from normal requirement of fluids and one glass for every loose motion passed again. 

For up to 12 loose motions, a patient can be managed as an outpatient but if the loose motions are more than 12, he needs observation and if the numbers of loose motions are more than 40, he needs intensive treatment. 

The main complication is renal shut down, which will happen if the blood pressure remains low for more than few hours. During loose motions, one should maintain that he or she passes urine every 6-8 hours. If no urine is passed for eight hours it may indicate an impending renal failure.One loose motion is equal to one glass of ORS. Most summer diarrhea is watery, effortless and painless diarrhea with no mucous or blood. No antibiotic is needed. The only treatment is oral rehydration solution. 
One loose motion is equivalent to loss of one glass of fluid. If a patient has passed 10 loose motions, he needs 12 glasses of ORS apart from normal requirement of fluids and one glass for every loose motion passed again. 

For up to 12 loose motions, a patient can be managed as an outpatient but if the loose motions are more than 12, he needs observation and if the numbers of loose motions are more than 40, he needs intensive treatment. 

The main complication is renal shut down, which will happen if the blood pressure remains low for more than few hours. During loose motions, one should maintain that he or she passes urine every 6-8 hours. If no urine is passed for eight hours it may indicate an impending renal failure.One loose motion is equal to one glass of ORS. Most summer diarrhea is watery, effortless and painless diarrhea with no mucous or blood. No antibiotic is needed. The only treatment is oral rehydration solution. 

One loose motion is equivalent to loss of one glass of fluid. If a patient has passed 10 loose motions, he needs 12 glasses of ORS apart from normal requirement of fluids and one glass for every loose motion passed again. 

For up to 12 loose motions, a patient can be managed as an outpatient but if the loose motions are more than 12, he needs observation and if the numbers of loose motions are more than 40, he needs intensive treatment. 

The main complication is renal shut down, which will happen if the blood pressure remains low for more than few hours. During loose motions, one should maintain that he or she passes urine every 6-8 hours. If no urine is passed for eight hours it may indicate an impending renal failure.

Treatment of Fatty Liver

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , | | Comments Off on Treatment of Fatty Liver

  • 10 % weight loss can improve fatty liver and possibly inflammation.
  • Metformin and ursodeoxycholic acid are not recommended.
  • Statins are safe in patients with fatty liver but whether they can reduce fatty liver is not known.
  • Omega-3 fatty acids have been tried
  • Pioglitazone is useful in the treatment of biopsy-proven fatty liver with inflammation
  • Vitamin E at a dose of 800 IU/day improves liver inflammation
  • Use of bariatric surgery for treatment of fatty liver is premature and should be avoided in patients with cirrhosis.

Treatment of Fatty Liver

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , | | Comments Off on Treatment of Fatty Liver

  • 10 % weight loss can improve fatty liver and possibly inflammation.
  • Metformin and ursodeoxycholic acid are not recommended.
  • Statins are safe in patients with fatty liver but whether they can reduce fatty liver is not known.
  • Omega-3 fatty acids have been tried.
  • Pioglitazone is useful in the treatment of biopsy-proven fatty liver with inflammation.
  • Vitamin E at a dose of 800 IU/day improves liver inflammation
  • Use of bariatric surgery for treatment of fatty liver is premature and should be avoided in patients with cirrhosis.

Treatment of Fatty Liver

By Dr K K Aggarwal
Filed Under Health Care - Ask Dr KK | Tagged With: , | | Comments Off on Treatment of Fatty Liver

  • A 10% weight loss can improve fatty liver and possibly inflammation.
  • Metformin and ursodeoxycholic acid (UDCA) are not recommended.
  • Statins are safe in patients with fatty liver but whether they can reduce fatty liver is not known.
  • Omega–3 fatty acids have been tried
  • Pioglitazone is useful in the treatment of biopsy–proven fatty liver with inflammation
  • Vitamin E at a dose of 800 IU/day improves liver inflammation
  • Use of bariatric surgery for treatment of fatty liver is premature and should be avoided in patients with cirrhosis.

Give BP Drugs at Night

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , | | Comments Off on Give BP Drugs at Night

Blood pressure drugs should be taken at night.

Uncontrolled blood pressure can lead to heart attacks, paralysis and heart failure. Most such attacks occur in the early morning hours. Pulse, blood pressure and thickening of platelets are all higher in the early morning hours.

Controlling early morning blood pressure can reduce cardiovascular mortality.

According to a study published in the Journal of the American Society of Nephrology, among patients with chronic kidney disease and high blood pressure, taking at least one antihypertensive drug at bedtime significantly improves blood pressure control, with an associated decrease in risk for cardiovascular events.

The study included 661 patients with chronic kidney disease who were randomly assigned either to take all prescribed anti BP drugs on awakening or to take at least one of them at bedtime. Patients were followed for a median of 5.4 years; during that time, patients who took at least one BP-lowering drug at bedtime had approximately one third of the cardiac risk compared with those who took all medications on awakening.

A similar significant reduction in cardiac deaths, heart attacks and paralysis was noted with bedtime dosing. Patients taking their medications at bedtime also had a significantly lower mean BP while sleeping.

For each 5 mmHg decrease in mean sleep-time systolic upper BP, there was a 14% reduction in the risk for cardiovascular events during follow-up.

Potential explanation for the benefit of night time treatment may be associated with the effect of night time treatment on urinary albumin excretion levels. Urinary albumin excretion is significantly reduced after bedtime, but not morning, treatment.

Summer Diarrhea Treatment

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on Summer Diarrhea Treatment

One loose motion is equal to one glass of ORS. Most summer diarrhea is watery, effortless and painless diarrhea with no mucous or blood. They need no antibiotics. The only treatment is oral rehydration solution.

One loose motion is equivalent to loss of one glass of fluid. If a patient has passed 10 loose motions, he needs 12 glasses of ORS apart from normal requirement of fluids and one glass for every loose motion passed again.

For up to 12 loose motions, a patient can be managed as an outpatient but if the loose motions are more than 12, he needs observation and if the numbers of loose motions are more than 40, he needs intensive treatment.

The main complication is renal shut down, which will happen if the blood pressure remains low for more than few hours. During loose motions, one should maintain that he or she passes urine every 6-8 hours. If no urine is passed for eight hours it may indicate an impending renal failure.

Every arthritis is not the same

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

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 50+ age group 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.

Treatment of Summer Diarrhea

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , | | Comments Off on Treatment of Summer Diarrhea

Most summer diarrhea is watery, effortless and painless diarrhea with no mucous or blood. They need no antibiotics. The only treatment is oral rehydration solution.

One loose motion is equivalent to loss of one glass of fluid. Explaining this, Dr. Aggarwal said that if a patient has passed 10 loose motions, he needs 12 glasses of ORS apart from normal requirement of fluids and one glass for every loose motion passed again.

For up to 12 loose motions, a patient can be managed as an outpatient but if the loose motions are more than 12, he needs observation and if the numbers of loose motions are more than 40, he needs intensive treatment.

The main complication is renal shut down, which will happen if the blood pressure remains low for more than few hours. During diarrhea, urine should be passed every 6-8 hours. If no urine is passed for eight hours it may indicate an impending renal failure.

Treatment of mild hypertension in low–risk patients

By Dr K K Aggarwal
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There is no convincing data to show the benefit from antihypertensive therapy in patients with mild hypertension and no preexisting cardiovascular disease. A meta–analysis combined four placebo-controlled trials totaling 8912 patients with mild hypertension and no preexisting cardiovascular disease (1). During 4 to 5 years of follow–up, antihypertensive therapy resulted in lower rates of mortality and stroke but higher rates of myocardial infarction. Low–risk patients with mild hypertension and no preexisting cardiovascular disease who fail to reduce their blood pressure with lifestyle modification should receive antihypertensive therapy.

Treatment of hypertension in frail older adults

Older adults who are frail may not benefit from antihypertensive therapy. In an observational study of 2340 adults older than 65 years, the association between blood pressure and mortality was examined according to whether or not individuals were frail (2). Frail is defined as an inability to walk 6 meters in less than 8 seconds. Among frail adults, there was no association between blood pressure and mortality. In addition, a higher blood pressure was associated with a lower risk of death among the most frail (i.e., those who could not walk the distance at all).

References

  1. Diao D, Wright JM, Cundiff DK, Gueyffier F. Pharmacotherapy for mild hypertension. Cochrane Database Syst Rev 2012;8:CD006742.
  2. Odden MC, Peralta CA, Haan MN, Covinsky KE. Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med 2012;172:1162.

Treatment of Fatty Liver

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , | | Comments Off on Treatment of Fatty Liver

  • A 10% weight loss can improve fatty liver and possibly inflammation.
  • Metformin and ursodeoxycholic acid (UDCA) are not recommended.
  • Statins are safe in patients with fatty liver but whether they can reduce fatty liver is not known.
  • Omega–3 fatty acids have been tried
  • Pioglitazone is useful in the treatment of biopsy–proven fatty liver with inflammation
  • Vitamin E at a dose of 800 IU/day improves liver inflammation
  • Use of bariatric surgery for treatment of fatty liver is premature and should be avoided in patients with cirrhosis.

You Can Die Because Of Treatment and Availability of Medical Technology

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Medscape gives the following 10 examples.

  1. Surgical fires: There are an estimated 600 surgical fires per year in US alone leading to devastating consequences, including disfigurement and death. The fire triangle is oxidizers, ignition.
  2. Texting while performing surgical procedures:Mobiledevices now make it easier for clinicians to be interrupted for non-work-related reasons. Half of the respondents to a 2010 survey of perfusionists acknowledged texting during heart-lung bypass procedures 2]with 15% further admitting that they accessed the Internet and 3% reporting that they visited social networking sites during procedures. These devices can divert the caregiver’s attention away from the patient or the task at hand.
  3. Dirty endoscopes and surgical instruments: Cross-contamination hazards can occur when flexible endoscopes aren’t properly reprocessed.
  4. Using technology for adults on children: Technology designed for adults are used on children as no alternatives exist. They can be risky
  5. Air embolism hazards: Intravascular air embolism is a potentially lethal complication of certain medical and surgical procedures. The largest percentage of reported events is associated with the use of central venous access devices.
  6. Devices and IT systems that don’t interface: Interfaces between medical devices don’t always function as intended and can allow dangerous conditions to exist. For example monitoring system may not communicate audible or visual alarms from an interfaced ventilator to warn caregivers of a critical patient circuit disconnection.
  7. Patient data errors in EHRs and health IT: One patient’s data can end up in another patient’s record.
  8. Radiation burns from diagnostic radiology procedures: Inappropriate use and dose levels of CT can lead to unnecessary radiation exposure for patients. Image quality typically improves as the dose increases. As a result, there is a tendency to use higher doses that are associated with greater risk to the patient. Acute reactions such as radiation burns and hair loss are relatively rare but still occur too frequently.
  9. Medication administration errors using infusion pumps: Infusion devices are the subject of more adverse incident reports to the US Food and Drug Administration than any other medical technology, according to the Association for the Advancement of Medical Instrumentation. From 2005 through 2009, more than 700 deaths associated with infusion devices were reported.
  10. Alarm hazards alarms on infusion pumps, ventilators, and other devices: sheer number of alarms in a hospital can overwhelm staff, leading to complacency and delayed response. Caregivers often turn down the volume of alarms. Too many alarms sounding can lose its purpose.

 

Treatment of Fatty Liver

By
Filed Under Wellness | Tagged With: , , , | | Comments Off on Treatment of Fatty Liver

• 10 % weight loss can improve fatty liver and possibly inflammation.
• Metformin and ursodeoxycholic acid are not recommended.
• Statins are safe in patients with fatty liver but whether they can reduce fatty liver is not known.
• Omega-3 fatty acids have been tried
• Pioglitazone is useful in the treatment of biopsy-proven fatty liver with inflammation
• Vitamin E at a dose of 800 IU/day improves liver inflammation
• Use of bariatric surgery for treatment of fatty liver is premature and should be avoided in patients with cirrhosis.