The science behind observing Shradhs

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Shradhs are observed every year in Dakshinayana during Chaturmas in the Krishna Paksha of Ashwin month. Many rituals are performed to satisfy the unfulfilled desires of three generations of our ancestors.

According to the Vedas, every individual has three debts to be paid off, firstly, the Devtas (Dev Rin), secondly of Guru and teachers (Rishi Rin) and, thirdly, of Ancestors (Pitra Rin).  From the scientific point of view, devtas represent people with Daivik qualities; teachers the ones who have taught us and Pitra, three generations of our ancestors. ‘Rin’ from scientific point of view would mean unfinished desires or tasks.

The rituals scientifically would mean detaching oneself from the guilt of unfinished task of our ancestors by detoxifying our mind.

Debt means desires of our ancestors that had not fulfilled during their lifetime. The responsibility to fulfill them automatically falls onto the eldest son in the family and they need to be carried out. If not, it is a sign of guilt disorder in the family and may present with loss of wealth, loss of direction and courage and health. The resultant problems faced were called Pitra Dosh in mythology.

The ritual of performing Shradhs originated to remove this guilt and the resultant illnesses. Shradh has many components.

  • Tarpan (offering water to the ancestors while reciting Mantras).
  • Arpan (preparing food what the ancestors used to like on the day of Shradh)
  • Brahmin bhoj (offering Satvik food to Brahmins)
  • Pind Daan (offering black sesame, Kusha Grass, Jwar and boil or baked rice); observed by some.
  • Observing a spiritual holiday or incubation period (taking a break from the routine worldly desires and going to a distant place like Gaya).
  • Remembrance: Once the unfulfilled desires of the ancestors are over, remembering our ancestors every year on the day of their death anniversary.

Scientifically, Dakshinayana is the period of negative state of mind (nights are longer than days) and starts from 14th July and ends on 13th January. Chaturmas period (first four months) during Dakshinayana has the maximum negativity in the mind. Chaturmas includes the months of Sawan, Bhado, Ashwin and Kartik.

The negative state of mind in Sawan is related to anger and disturbed mind; in Bhado to non fulfillment of desires and uncontrolled ego and in the month of Ashwin to guilt because of non fulfillment of desires of others (ancestors), especially during Amavasya.

In the rituals ‘Tarpan’ of Jal (water) is offered to ancestors. ‘Jal’ in mythology means flow of thoughts and offering ‘Jal’ in mythology equates to confession and getting connected. Tarpan is always done with an aim to purify the mind and wash off the guilt.

‘Tarpan’ is always done after the desires of our ancestors have been fulfilled by the person performing the Shradh. This ritual is ‘Arpan’. Tarpan and Arpan on the day of Shradh mean getting connected to our consciousness and informing that all the unfinished tasks are over so that we can get rid of the long persisting guilt from our mind. Offering and making food which was liked by our ancestors on that day is just to remember and pay respect to them.

Confession is only possible in a Satwik state of mind, which requires eating of Satwik food for a few days. The ritual of offering Satwik food to Brahmins during the Shradh means making only Satwik food on that day so that everyone in the family is forced to eat Satwik food during Shradhs.

Pind Daan denotes medicinal ways of detaching oneself from the guilt. All the four offerings (black sesame, Kusha grass, Jwar and boiled or roasted rice) in Ayurveda have been described to detoxify the mind and making it Satwik by removing Rajas and Tamas.

If the guilt does not go by repeated Shradhs than one is required to go for a spiritual vacation during Shradh period so that he is away from the worldly desires for a few days before the Shradh and this is what going to Gaya means. This spiritual retreat works like an incubation period to the disturbed mind and gets rid off the disturbed mind and allows the undisturbed state of mind to confess and purify.

The Pitra ceremonies are usually performed either on Amavasya every month (period of most negativity in a month) or on the death anniversary or the Hindu Tithi (day) of the death of the ancestors coinciding with the day during Shradh days. If the date of death is not known then the Shradh is observed on Amavasya.

Some people perform Shradh for full 15 days and others perform it from the first day till the day of their ancestor Shradh.

It is said that once a Shradh is successfully performed or Gaya Shradh is performed, there is no need to perform Shradh rituals thereafter. Once the guilt is over, there is no need for further detoxification of the mind. After that the only ritual that needs to be performed is ‘remembrance”, which is usually performed on the death anniversary of the deceased ancestor usually by doing some charity on their names.

One is not supposed to do auspicious things during Shradh as during this period, the mind is in a process of detoxification.

Hepatitis B Vaccination update

Health Care, Medicine 556 Comments

• The regimen for the vaccine is three doses at one and six months apart.

• Longer than recommended intervals between doses do not reduce final antibody concentrations, although protection might not be attained until the recommended number of doses has been administered.(1-5)

• A positive immune response to the vaccine is defined as the development of hepatitis B surface antibody (anti-HBs) at a titer of >10 mIU/mL.

• An interruption in the vaccine schedule does not require restarting the entire series of vaccination or adding extra doses.(6,7)

• If the vaccination schedule is interrupted after the first dose, the second dose should be administered as soon as possible.(8)

• The second and third doses should be separated by an interval of at least two months.

• If only the third dose is delayed, it should be administered when convenient.

• Protective anti-HBs titers may be attained in some after only one or two doses of vaccine, completion of the full course (three doses) is recommended to maximize the anti-HBs titer and duration of protection.

• Anti-HBs titers decrease with time but the duration of protection is long (15 -22 years after the primary vaccination schedule).(9-13) Routine booster injections are not required.(14,15)

• Patients with serologic markers of past HBV infection (anti-HBc and anti-HBs positive) do not need HBV vaccination even if they have low titers of anti-HBs.

• Vaccines should be given intramuscularly since deposition of the vaccine into adipose tissue result in a lower seroconversion rate.(16)

• Deltoid is the preferred site in adults for vaccination.

• Longer needles should be used in overweight individuals.

• Hepatitis B vaccine is effective not only in preventing HBV infection but also in preventing the sequelae of chronic HBV infection.

• It is the first example that cancer can be prevented by vaccination.

References

1. Wiström J, Ahlm C, Lundberg S, et al. Booster vaccination with recombinant hepatitis B vaccine four years after priming with one single dose. Vaccine 1999;17:2162.

2. Zechowy R, Rubin LG. Effect of the time interval between the first and second doses of hepatitis B vaccine on the antibody titer achieved after the third dose. Child Hos Q 1997;9:67.

3. Middleman AB, Kozinetz CA, Robertson LM, et al. The effect of late doses on the achievement of seroprotection and antibody titer levels with hepatitis b immunization among adolescents. Pediatrics 2001;107:1065.

4. Halsey NA, Moulton LH, O’Donovan JC, et al. Hepatitis B vaccine administered to children and adolescents at yearly intervals. Pediatrics 1999;103:1243.

5. Heron LG, Chant KG, Jalaludin BB. A novel hepatitis B vaccination regimen for adolescents: two doses 12 months apart. Vaccine 2002;20:3472.

6. Saito K. Introductory remark of Dr. Rokuzo Kobayashi’s achievements. Keio J Med 2002;51 Suppl 2:2.

7. Hepatitis B vaccine: What you need to know. Available at: www.cdc.gov/vaccines/pubs/vis/downloads/vis-hep-b.pdf (Accessed on October 20, 2009).

8. Hoofnagle JH. Toward universal vaccination against hepatitis B virus. N Engl J Med 1989;321:1333.

9. Liao SS, Li RC, Li H, et al. Long-term efficacy of plasma-derived hepatitis B vaccine: a 15-year follow-up study among Chinese children. Vaccine 1999;17:2661.

10. Lin HH, Wang LY, Hu CT, et al. Decline of hepatitis B carrier rate in vaccinated and unvaccinated subjects: sixteen years after newborn vaccination program in Taiwan. J Med Virol 2003;69:471.

11. Yuen MF, Lim WL, Chan AO, et al. 18-year follow-up study of a prospective randomized trial of hepatitis B vaccinations without booster doses in children. Clin Gastroenterol Hepatol 2004;2:941.

12. McMahon BJ, Bruden DL, Petersen KM, et al. Antibody levels and protection after hepatitis B vaccination: results of a 15-year follow-up. Ann Intern Med 2005;142:333.

13. Zanetti AR, Mariano A, Romanò L, et al. Long-term immunogenicity of hepatitis B vaccination and policy for booster: an Italian multicentre study. Lancet 2005; 366:1379.

14. Lu CY, Chiang BL, Chi WK, et al. Waning immunity to plasma-derived hepatitis B vaccine and the need for boosters 15 years after neonatal vaccination. Hepatology 2004;40:1415.

15. Jan CF, Huang KC, Chien YC, et al. Determination of immune memory to hepatitis B vaccination through early booster response in college students. Hepatology 2010;51:1547.

16. Shaw FE Jr, Guess HA, Roets JM, et al. Effect of anatomic injection site, age and smoking on the immune response to hepatitis B vaccination. Vaccine 1989;7:425.

New Delhi metallo-beta-lactamase (NDM-1)

Health Care, Medicine, Social Health Community 1,531 Comments

Enterobacteriaceae isolates carrying a novel MBL gene, the New Delhi metallo-beta-lactamase (NDM-1) was first described in December 2009 in India with Klebsiella pneumoniae (1). Later, it was described in patients who had traveled to and undergone procedures in India and Pakistan (2). Cases were also reported in Asia, Europe, and North America (2-4). Isolates have also included E. coli and Enterobacter cloacae (2).

Risk factors

  1. Recent treatment with carbapenem
  2. Indwelling urinary or venous catheters
  3. Severe illness (5)
  4. NDM-1 can inactivate all beta-lactams except aztreonam.

Salient points

1.    It is an important emerging resistant pathogen (6).

2.     NDM1 isolates are susceptible to colistin or tigecycline

3.    The susceptibility is short-lived.

4.     NDM-1 has been identified in public water supplies in India (7)

References

  1. Yong D, Toleman MA, Giske CG, et al. Characterization of a new metallo-beta-lactamase gene, bla(NDM-1), and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother 2009;53:5046.
  2. Kumarasamy KK, Toleman MA, Walsh TR, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis 2010;10:597.
  3. Centers for Disease Control and Prevention (CDC). Detection of Enterobacteriaceae isolates carrying metallo-beta-lactamase – United States, 2010. MMWR Morb Mortal Wkly Rep 2010;59:750.
  4. Sidjabat H, Nimmo GR, Walsh TR, et al. Carbapenem resistance in Klebsiella pneumoniae due to the New Delhi Metallo-β-lactamase. Clin Infect Dis 2011;52:481.
  5. Deshpande P, Shetty A, Kapadia F, et al. New Delhi metallo 1: have carbapenems met their doom? Clin Infect Dis 2010;51:1222.
  6. Nordmann P, Poirel L, Toleman MA, Walsh TR. Does broad-spectrum {beta}-lactam resistance due to NDM-1 herald the end of the antibiotic era for treatment of infections caused by Gram-negative bacteria? J Antimicrob Chemother 2011;66:689.
  7. Walsh TR, Weeks J, Livermore DM, Toleman MA. Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study. Lancet Infect Dis 2011;11:355.

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