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Dr K K Aggarwal

First aid for poisonous bites and stings

By Dr K K Aggarwal
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People often panic if they have been bitten or stung. You should tell the patient that many snakes, spiders, insects and sea creatures are harmless and that even the bites and stings of dangerous animals often do not cause poisoning.

Keep the patient calm and still. Moving the bitten or stung limb speeds up the spread of venom to the rest of the body. Fear and excitement also make the patient worse. The patient should be told not to use the limb and to keep it still and below the level of the heart. The limb may swell after a while, so take off the patient’s rings, watch, bracelets, anklets and shoes as soon as possible. A splint and a sling may help to keep the limb still.

Avoid doing the following:

• Do not cut into the wound or cut it out.

• Do not suck venom out of the wound. • Do not use a tourniquet or tight bandage.

• Do not put chemicals or medicines on the wound or inject them into the wound (for e.g., potassium permanganate crystals).

• Do not put ice packs on the wound.

• Do not use proprietary snake bite kits.

• The patient should lie on one side in the recovery position so that the airway is clear, in case or vomiting or fainting.

• Do not give the patient anything by mouth – no food, alcohol, medicines or drinks. However, if it is likely to be a long time before the patient gets medical care, give the patient water to drink to stop dehydration.

• Try to identify the animal, but do not try to catch it or keep it if this will put you, the patient or others at risk. If the animal is dead take it to hospital with the patient, but handle it very carefully, because even dead animals can sometimes inject venom.

• As soon as possible, take the patient to a hospital, medical dispensary, or clinic where medical care can be given. The patient should not walk but should keep as still as possible. If there is no ambulance or car, carry the patient on a stretcher or trestle, or on the crossbar of a bicycle.

• Antivenom should only be given in a hospital or medical Centre where resuscitation can be given, because the patient may have an allergic reaction. If available, antivenom should be used if there is evidence of severe poisoning. It should not be used when there are no signs of poisoning.

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Cycling can cause erectile dysfunction

By Dr K K Aggarwal
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Age, diabetes, hypertension, obesity, high lipids, smoking, drugs, heart disease, upright cycling for more than 3 hours a week can cause erectile dysfunction in males. For those who ride bicycles for more than 3 hours a week should do so in a reclining position and not upright position.

A man is considered to have erectile dysfunction when he cannot acquire or sustain an erection of sufficient rigidity for sexual intercourse. Any man may, at one time or another during his life, experience periodic or isolated sexual failures.

The term “impotent” is reserved for those men who experience erectile failure during attempted intercourse more than 75 percent of the time. Heart disease increases the risk for later erectile dysfunction. Erectile dysfunction may be an early warning sign of future heart disease. Men with erectile dysfunction without an obvious cause (e.g., pelvic trauma), and who have no symptoms of heart disease, should be screened for heart disease prior to treatment since there are potential cardiac risks associated with sexual activity in patients with heart disease.

Eight of the 12 most commonly prescribed medications list impotence as a side effect and it is estimated that 25 percent of cases of erectile dysfunction are due to drugs.

Depression, stress, or the drugs used to treat depression can result in erectile dysfunction.

Neurologic causes of erectile dysfunction include stroke, spinal cord or back injury, multiple sclerosis, or dementia. In addition, pelvic trauma, prostate. Surgery or priapism may cause erectile dysfunction.

Bicycling, less obvious, but of increasing importance, has been the possible association of erectile dysfunction with bicycling. Anything that places prolonged pressure on the pudendal and cavernosal nerves or compromises blood flow to the penile artery can result in penile numbness and impotence.

Cycling-induced impotence, is primarily a problem of serious cyclists and has been reported to occur in Norwegian men competing in a 540 km bicycle race.

The penile numbness is attributed to the pressure on the perineal nerves whereas the erectile dysfunction is thought to be due to a decrease in oxygen pressure in the pudendal arteries.

Recreational cyclists, those who cycle for less than 3 hours per week and men who cycle in a reclining position avoid the sustained intense pressure on the penile nerve and artery and are less likely to experience sexual side effects. Continued cycling in a seated upright position can reduce the penile oxygen levels lasting 10 minutes.

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Dark Chocolate good for the heart

By Dr K K Aggarwal
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Dark chocolate is thought to promote relaxed arteries, also have biochemical effects that may discourage atherosclerosis suggests a report published in the March 2014 issue of the FASEB Journal.

In a randomized, double–blind study, eating dark chocolate—acutely and over weeks—not only improved objective measures of endovascular function, it also improved biochemical markers that reflect leukocyte activation, inflammation, and other signs of atherogenesis.

Changes in endothelial function were reflected in improved flow–mediated dilation (FMD), blood pressure, and augmentation index, while “changes in leukocyte–cell counts, plasma cytokines, and leukocyte adherence markers after chocolate consumption point toward a less–activated state of cellular adherence and, hence, a less atherogenic milieu, according to the authors, led by Dr Diederik Esser (Top Institute Food and Nutrition and Wageningen University, the Netherlands).

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Women beware of heart disease

By Dr K K Aggarwal
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More women die of cardiovascular disease than from the next four causes of death combined, including all forms of cancer.

Over 80 percent of cardiac events in women could be prevented by modifying diet, exercise and abstinence from smoking.

Following may be the warning signals of heart attack

Uncomfortable pressure, squeezing, fullness or pain in the center of the chest. It lasts more than a few minutes, or goes away and comes back.

Pain or discomfort in one or both arms, the back, neck, jaw or stomach.

Shortness of breath with or without chest discomfort.

Breaking out in a cold sweat, nausea or lightheadedness.

As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

In presence of any of the above one should not wait for more than five minutes and get to a hospital right away.

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Facts

1. In the United States, 0.3% of all cases require admissions.

2. The mortality rate of flu pandemic is 0.12 deaths per 100,000 population.

3. Total number of deaths caused by pandemic H1N1 influenza A in the United States was lower than the number of deaths caused by seasonal influenza during non-pandemic years 4. Early and prompt initiation of antiviral therapy is recommended for children, adolescents, or adults with suspected or confirmed swine flu with any of the following features:

o Flu requiring hospitalization

o Progressive, severe, or complicated flu

o Severely immunosuppressed patients (receiving treatment for malignancies, hematopoietic or solid organ transplant recipients)

o Swine flu at high risk for complications:

• Children <5 years particularly those <2 years

• Elderly =65 years

• Pregnant women

• Women up to 2 weeks postpartum

• Residents of nursing homes and other chronic care facilities

• Individuals with chronic medical conditions including: lung disease, including asthma (particularly if steroids have been required during the past year); heart disease, except isolated hypertension; active malignancy; chronic kidney disease, chronic liver disease, diabetes, sickle cell disease, other chronic disabling diseases and morbid obesity.

5. Severity of flu

o Asymptomatic swine flu: Many contact illnesses may pass off without symptoms. In all 19 percent had serologically confirmed infection and 28 percent of those who were infected may remain asymptomatic.

o Mild or uncomplicated swine flu (require no treatment, no hospitalization, no investigations)

• Fever, cough, sore throat, nasal discharge, muscle pain, headache, chills, malaise and sometimes diarrhea and vomiting

• No shortness of breath

• Little change in chronic health conditions.

o Progressive illness. Requires hospitalization

• Above symptoms plus

• Chest pain

• Poor oxygenation (high respiratory rate, hypoxia, labored breathing in children)

• Low blood pressure

• Confusion, altered mental status

• Severe dehydration

• Exacerbations of asthma, chronic bronchitis, chronic renal failure, diabetes, or other cardiovascular conditions

o Severe or complicated illness requires hospitalization

• Signs of lower respiratory tract disease

• Low oxygen requiring supplemental oxygen

• Pneumonia on x-ray

• Brain involvement

• BP lower than 80, organ failure

• Heart involvement

• Persistent high fever and other symptoms beyond 3 days

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Shoe Hygiene

By Dr K K Aggarwal
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• Avoid poorly fitting shoes.

• Diabetic patients should avoid walking bare feet. • Shoes that are too tight can cause pressure ulcers.

• High heels are okay for occasions but if you wear them all the time, significant foot pain and other problems can develop ranging from bunions, corns and calluses to more complex problems like misshapen hammer toes or worsening excruciating pain in the ball of the foot.

• Whenever you wear shoes that are tight, they will cause foot pain.

• Whenever you wear shoes that constrict the natural shape of the foot, they are bound to cause foot pain.

• Women, who regularly wear high heels, walk with shorter, more forceful strides and require more muscles to walk.

• Shoes can be classified under following three categories: o Good shoes or low risk shoes: athletic and casual sneakers. o Average mid risk shoes: hard or rubber–soled shoes – special shoes and work boots. o Poor or high risk shoes are the ones that do not have support or structure such as high heels, sandals, sleepers.

• Pointed toed shoes are equally bad as they disrupt the natural shape of the feet.

• If you love to wear heels, then choose heels that are not higher than 2″ and are wide.

• It is always better to buy shoes in the evening as the foot swells up by evening. If you buy them in the morning, the shoes may feel tight in evening hours.

• Always try both shoes as one foot may be smaller or larger than the other one in some people.

• Always wear the shoes that are wider than your foot.

• The actual size of the shoe may vary between different manufactures.

• The selected shoe should be wider than broadest part of the foot.

• Your foot tends to become longer and wider as you age, always check the size of your shoes every two years.

• Narrow shoes with heels should only be used for a function, dinner or a formal party, specially a party where you do not have to stand for a longer time.

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Physical illness can trigger depression

By Dr K K Aggarwal
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If you have depression, a thorough physical exam and careful medical history should be evaluated to pinpoint a physical source of the problem for an appropriate treatment. In individuals with depression, do not only look for what’s going on in the mind and brain, but also check what’s going on in the body. Many medical problems are linked to mood disturbances.

Over 50% of heart attack survivors and those with cancer report feeling depressed. Depression is also linked to diabetes, Parkinson’s and other chronic conditions. Thyroid disorders also affect mood. Overactive thyroid can cause mania and under active thyroid can cause depression. Other medical conditions associated with mood disorders include certain neurological conditions (multiple sclerosis, Parkinson’s disease, Alzheimer’s), other hormonal imbalances, and lack of vitamin B12.

Depression can affect the course of a physical disease. Depression is linked with slower recovery from a heart attack and an increased risk for future heart trouble.

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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 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. Another form of joint disorder is gout, which is never seen in children and 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. 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 crosslegged, 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.

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