Breastfeeding within first few hours critical for a baby’s immune system

Health Care, Heart Care Foundation of India Comments Off

Colostrum provides essential nutrients and reduces the risk of death by about 22%

New Delhi, 31 July 2018: About 7.8 crore newborns around the world are not breastfed within their first hour of life thus lowering their chance of survival and meeting the growth, developmental, and intellectual potential. Most of these newborns are born in low-and-middle-income countries, including India, where 41.5% of the 2.6 crore babies born every year get breastfed within the first critical hour of birth.

Breastfeeding within the first few hours and later at least for the first six months of the infant’s life is extremely essential. Colostrum, the thick, sticky, yellowish milk mothers produce during the first few days after delivery provides essential nutrients as well as antibodies to babies. It protects them from infections and reduces the risk of death by up to 22% in the first month of life.

Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President, HCFI, said, “There is research to indicate that babies exclusively breastfed for the first six months of life have stronger immunity. They also have lower infection rate, higher intelligence and emotional quotient, as also better nutritional status. There are various factors due to which a majority of newborns may miss out on the initial few hours of breastfeeding. Some of these include traditional practices such as feeding honey or sugar water to the baby; availability of formula milk, lack of enough breast milk in the mother, or delayed initiation to feeding due to a Cesarean section or other issues.

Breast milk in itself is a complete food and is sufficient for the baby’s growth upto 6 months. After that, breastfeeding can be continued along with solid foods up to the age of 2 years. It can be continued for as long as the mother and baby desire.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “It is important for a nursing mother to take good rest, keep hydrated and eat a nutritious diet. Though you may find it difficult initially, once this becomes a habit, things are bound to get better. It is advisable to takerelaxing evening walks with your baby to get some fresh air. Accommodate light stretching exercises into your schedule to keep your body fit and prevent joint and muscle stiffness.

Some tips from HCFI

  • Avoid fatty, oily, gassy, and spicy foods or those containing too much salt or sugar. Take a diet rich in healthy calories and protein as breastfeeding can drain you out. Eat plenty of fresh fruits and vegetables, legumes, low fat dairy, lean meats, brown rice and leafy greens.
  • Drink adequate water to maintain a good supply of milk. Avoid caffeinated drinks such as tea and coffee. Restrain from smoking and drinking alcohol.
  • It is also important for breastfeeding mothers to maintain good breast hygiene. Infections or cracks in the nipples can not only affect you but also your baby and the entire breastfeeding routine.
  • Clean the nipple with warm water after every feed and moisturise. Take a bath everyday. Shower twice during a hot summer day. Do not use soap or other chemical-based cleansers to clean the breast.

Should aspirin be discontinued preoperatively in patients undergoing non-cardiac surgery?

Health Care Comments Off

If the patient is on aspirin for primary prophylaxis, then discontinue aspirin for 5 to 7 days before the surgery. Restart as soon as the perioperative risk of major bleeding has passed.
If the patient is on long-term aspirin for secondary prophylaxis, continue aspirin in patients with prior PCI with stenting and those undergoing carotid endarterectomy, unless the risk of major bleeding is thought to be high (POISE-2 trial) or the surgery involved is not likely to have bleeding controlled by homeostasis (prostate surgery, intra ocular surgery, intra cranial surgery).
Aspirin can be safely continued in most patients undergoing minor dental surgery or dermatologic procedures.
Guidelines from the American Society of Regional Anesthesia (ASRA) suggest that NSAIDs, including aspirin do not create a level of risk that will interfere with the performance of neuraxial blocks, and should not impact catheter techniques, timing of neuraxial catheter removal, or postoperative monitoring.
Discontinue cilostazol for at least 2 to 3 days prior to an elective surgery.
There is no data on the safety of dipyridamole if continued in the perioperative period. If discontinued, the drug should be stopped at least 2 days before surgery.
Dual antiplatelet therapy (DAPT) after PCI with stenting

Defer non-emergent noncardiac surgery for at least 6 months irrespective of stent type. In patients who must undergo non-emergent (time sensitive) noncardiac surgery prior to six months, attempt to defer surgery for at least three months after bare metal or drug-eluting stent placement. In patients for whom surgery before three months is in their best interest after weighing risks and benefits, refer patients as early as one month after stent placement.
For most patients undergoing noncardiac surgery who are taking DAPT after PCI with stenting because they have not reached the recommended minimum duration of such therapy, continue DAPT, as opposed to stopping it prior to surgery
In patients for whom the risk of bleeding is likely to exceed the risk of a perioperative event due to the premature cessation of DAPT, continue aspirin alone.
Stop both antiplatelet agents, in patients for whom a bleeding complication could be catastrophic, such as patients undergoing neurosurgical, prostate, or posterior eye procedures.
For patients taking DAPT after PCI with balloon angioplasty who are scheduled to undergo elective noncardiac surgery, wait at least 14 days after PCI
Clopidogrel, prasugrel, and ticagrelor when stopped should be stopped 5, 7 and 3-5 days, respectively, before surgery.
Clopidogrel, if stopped, should be restarted with a loading dose of 300-600 mg as soon as possible after surgery, perhaps even later in the day if postoperative bleeding has stopped.
Surgery be performed in centers with 24-hour interventional cardiology coverage
Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Monsoon fever can be deceptive and dangerous

Health Care, Heart Care Foundation of India, Medicine Comments Off

Any medication should be taken only in consultation with a specialist

New Delhi, 30 July 2018: The number of those with fever and other associated conditions increases during monsoons in India, indicate statistics. However, in this season, any episode of fever should not be taken lightly as there may be many diseases responsible, the commonest being viral, malaria, dengue, or Chikungunya. Awareness need to be created on identifying the warning signals and getting expert help at the earliest to avoid comorbidities.

With the monsoon, varsharitu starts in India. In Ayurveda, it is the time for aggravation of Vata or the movement functions in the body. While this is a time to rejoice, it is also imperative to take certain precautions, especially in children, failing which they can become susceptible to a host of diseases and infections.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “While one should not ignore persistent fever during monsoons, it is also important to not indulge in self-diagnosis. Fever can be an indication of various conditions and monsoon fever, in particular, can be deceptive. Viral fever is associated with cough, redness of the eyes or nasal discharge. Dengue is accompanied by fever with rash and pain in eye movement. Chikungunya is a triad of fever, rash, and joint pain. Typically, the joint pain increases on compression of the joint. Malarial fever comes with chills and rigors and will have a normal phase in between two episodes of fever. Fever in jaundice disappears after the onset of the condition. Lastly, typhoid fever is often continuous with a relatively low pulse rate and with toxic feeling.”

Many of the diseases in this season occur due to water stagnation and resultant breeding of mosquitoes. Contamination of drinking water is also common. It is important to drink clean and pure water to prevent diarrhea and gastrointestinal infections.

Adding further, Dr Aggarwal, who is also the Vice President of CMAAO, said, “There is no need to consume antibiotics unless there is a feeling of toxemia. Antibiotics in cases of sore throat are only required if associated with pain in the throat while swallowing food or red angry–looking tonsils. Except for paracetamol or nimesulide, other anti-fever medicines should not be used indiscriminately as they can reduce a person’s platelet count. Most diseases in this season are self-limiting and can take 4 to 7 days to resolve. The basic precaution involves proper hydration, especially on the days when fever is subsiding.”

Some tips from HCFI

  • Eat light food as the GI system of the body cannot digest heavy food.
  • Do not eat leafy vegetables without washing or boiling as they may be contaminated with eggs of round worms. Beware of eating snacks at some outside stall.
  • Beware of electrical deaths in this season as the coolers without earthing can leak electricity.
  • Do not walk barefooted as most worms can come out and cause the infection. Do not keep wet clothes and leather without proper drying them as they may attract fungus.
  • With each shower of rain, the BP may fluctuate so medications must be revisited.
  • Do not play in stagnant water as rat urine mixed with rain water may produce lactosyrosis (fever with jaundice)
  • Do not let water accumulate in the house or surrounding areas. Drink only boiled or safe water as there are more chances of diarrhea, jaundice, and typhoid in this season.

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