Musings of A MedMan

ABO Incompatibility- Important Concepts.

2025-11-17T14:39:00.003-05:00

ABO Incompatibility- Important Concepts. Pradeep Alur, MD.

ABO incompatibility exists only when mother is “O” and the baby is A or B blood group. Why?
As all those with O blood group will have anti-A and anti-B antibodies in their serum, why do we still do Coombs (Indirect) test for antibodies in the mother?
If the mother with O blood group has positive Coombs test, do we still need to do Coombs in the baby?
If the mother is Coombs test negative with O blood group, do we still need to do Direct Antibody (Coombs) test in the baby with A or B blood group?
Is there relevance in doing Coombs test in both the baby and the mother? Should we restrict it to the baby alone?

ANSWER 1-- ABO incompatibility occurs only when a mother has blood type O and the baby has either blood type A or B.

Explanation: In nature, individuals with blood types A and B produce anti-B and anti-A antibodies in their serum, respectively. These antibodies are of the IgM type, which do not cross the placenta. However, about 50% of people with blood type O have IgG-type anti-A and anti-B antibodies in their serum. Unlike IgM antibodies, IgG antibodies can cross the placenta, potentially leading to hemolysis in the baby.

ANSWER 2- Since all individuals with blood group O possess anti-A and anti-B antibodies in their serum, why is the Coombs (Indirect) test still performed to detect antibodies in the mother?

The Coombs test is designed to identify IgG-type antibodies against A and B blood groups, which are found in about 50% of individuals with blood group O. Since IgG antibodies have clinical significance, an Indirect Coombs test is conducted on the mother.

ANSWER 3- If a mother with O blood group has a positive Coombs test, is it still necessary to perform a Coombs test on the baby?

Explanation: IgG has four subclasses: IgG1, IgG2, IgG3, and IgG4. The G2 and G4 subclasses do not bind to the antigens on red blood cells (RBCs), while only G1 and G3 subclasses can adhere to these antigens. Since the Coombs test does not differentiate between the subclasses of IgG, it is essential to perform a Coombs test on the baby as well.

ANSWER 4- If a mother is Coombs test-negative and has an O blood group, is it still necessary to perform a Direct Antibody (Coombs) test on her baby if the baby has an A or B blood group?

Explanation: Studies have demonstrated that babies who test positive on the Coombs test often come from mothers who have only a one-third chance of also testing positive. This is due to the fact that the direct Coombs test is more sensitive than the indirect Coombs test. Therefore, it is advisable to conduct a direct Coombs test on the babies, even if the mother’s Coombs test result is negative.

ANSWER 5- Is there relevance in performing the Coombs test on both the baby and the mother, or should it be restricted to the baby alone?

The studies show that when the Coombs test is positive for both the mother and the baby, the risk of severe jaundice requiring phototherapy is high.

Transition phase of nutrition—optimizing nutrient administration

2025-11-17T11:24:00.002-05:00

Frontiers | Transition phase of nutrition—optimizing nutrient administration

his discussion explores the complex aspects of managing nutrition for preterm infants during the critical transition from exclusive parenteral nutrition (PN) to full enteral feeding (EN). The primary objectives of nutritional care in this very low birth weight infants (VLBW) population are to promote growth rates comparable to those in utero and enhance key neurodevelopmental milestones. The transition phase is characterized by the gradual increase of enteral feeds concurrently with the reduction and eventual cessation of parenteral nutrition. This period presents several key challenges in clinical practice, marked by notable variability: (A) determining the appropriate timing and criteria for initiating enteral feeds; (B) optimizing the rate at which enteral feed volumes are safely increased; (C) deciding the specific enteral volume threshold when to initiate human milk fortification to meet increasing caloric and protein demands; (D) establishing the optimal timing for discontinuing intravenous lipid emulsions (ILE); and (E) identifying the precise enteral volume threshold that dictates when to cease parenteral amino acid administration. To navigate these complexities and ensure seamless nutrient administration, practical recommendations for effective management are crucial. These include advocating for early fortification of human milk, judicious use of concentrated parenteral nutrition to provide adequate nutrients in lower fluid volumes, and strategically minimizing the overall duration of the transition phase. .....

A Dream Vacation- But Whose?

2025-05-27T21:32:00.009-04:00

A Dream Vacation- But Whose?

For 38 glorious years, my wife and I have been celebrating our wedding anniversary in some exotic locales. This year, I wondered, "How do we top this?" My research delved into those lesser-known resorts, the kind whispered about in travel forums. Many were impressive, but for the travel time? We’d spend more time getting there than being there. Then, I saw this resort clinging to a mountain cliff. It looked surreal! My excitement exploded instantly, and my expenditure followed suit concomitantly!

The combination of images and our imagination of our destination set our expectations higher for this dream vacation.

Like any exotic place, there was a dearth of direct flights. We chose the beloved airlines of America. The check-in was a breeze, and with extra fees, the seating was easy on the knees. The flight attendant walked down the aisle like a bride, graciously moving and smiling. She returned to her seat with poise, and the passengers watched without a noise. We all waited for her to be up on her feet to pass on a sweet treat! The smile she wore was not a bore, but we all expected something more. The bride never left the smile or the seat. The two-hour journey was filled with smiles and miles of hope and optimism. It appeared she analyzed our BMI and felt that the need to feed would indeed be a depraved deed. As the plane descended, so did our hopes. We got up easily as we were lighter and deplaned like a hungry tiger.

Our dome-shaped cabin was perched on a cliff with phenomenal valley views. The gentle, invigorating mountain breeze filled the air with the soothing chirping of birds. It was instantly enticing. Even those who never meditated may enter into a trance with this tranquilizing atmosphere!

We relished the slowly drifting clouds beneath us as our spirits soared above them! The two delightful days zipped by us so fast that we wondered if climate change was making the Earth spin quicker. It was captivating and fascinating.

Then came the "upgrade." We were moved to a cabin that was artistically, and somewhat alarmingly, wedged between two massive boulders, seemingly floating over a crevice. The structure was enigmatic, but my wife was ecstatic, and my instincts said it might be problematic! The maintenance crew, bless their hearts, helped us lug our stuff to this new wonder blunder: a cabin constructed entirely of mirrored glass.

The moment we stepped inside, the panoramic view was breathtaking – we could see everyone and everything outside. It was stunning. Wait a minute! Could outsiders see us, too, I wondered? The cheerful maintenance assured us that nobody can see us in the morning, only at night when we turn on the lights inside! Was that a reassurance or an assurance of an impending privacy mishap? I was puzzled. There were no water cannons outside the cabin to drive away the curious creatures. The safest place to change would be under the beds, if privacy is a priority, perhaps.

Even the bathroom is completely mirrored glass! Should I wear a Mardi gras mask in the bathroom to remain anonymous, or should I wear a bathrobe and shower to maintain my modesty? Never did I have to make such a tough decision in my career, let alone during a vacation. I had taken moral classes as a kid, but never about modesty! No curtain can be hung as it is smooth glass. Were we expected to fully embrace nature and attend to nature’s calls… out in nature? The cheerful maintenance cheered us that it was the most expensive newly constructed cabin and that we were the first to experience it. Hmm! Was that inspiring or merely a conspiring note? I was perspiring already. He reaffirmed that they are fully booked, and hence, this was the best choice we had. The gravity of the calamity of the reality began to sink in on us.

For the next three perplexing days, we lived amid Nature; what we saw was all nature, and what others saw was all natural! I did not dream of living this transparent life!

We chose perfect shower times when no one could see us and no one was around. The whole beautiful cabin was a microcube. The shower was a standing-only affair, and they meant it literally. You could stand. That’s it. Bending down to scrub your feet? Forget it. I noisily bumped my head on the glass wall, attempting that very maneuver. I had to support myself on the wall with one hand, carefully flex my knee upwards, and apply the soap with the other hand. However, after going for the yoga class the next day, I realized that yoga's tree pose perfectly suited this type of showering. Though it took several attempts to maintain the perfect balance, the goal was achieved by the final day. It’s a dream come true. Yoga and shower in one sitting, I mean, standing!

Even brushing in the morning required yoga. Clearly an afterthought, the faucet was tiny enough to be shoehorned into this nano-bathroom beside the shower. To spit the toothpaste, you must gradually squat and carefully aim the minuscule faucet lest you decorate yourself. Was this brushing ritual also meant to tone the girdle? Brushing would have been a breeze if I had learned the ara mandi pose in Bharatanatyam.

The bedspace was undoubtedly squeezed. The moment you slide out of the bed, you are practically in the nano bathroom. I suspect this design caters to two types of couples: the madly-in-love, inseparable kind, or those teetering on the brink of separation. There was not much square footage to remain separate in this micro-nanocube. You have to practice detachment in attachment to survive. Wow! It induced a spiritual angle to this micro living. When someone said that yoga should be part of life, I wondered if he lived in this microcosm to proclaim that transparent truth!

As we began to adjust and enjoy this beautiful cliffside living, we received an emergency alert for a tornado warning. Maybe we should have also taken some paragliding safety classes, lest we experience free paragliding thanks to a tornado on this cliff! Well, fortunately, the warning waned without a warning. Ironically, we found a sign for a cliffside paragliding adventure. Curious as we were, we immediately turned onto that road.

Strange enough, there was no building other than just the one to our right. We wondered if other buildings just glided down the cliff! Inquisitive enough, we parked our car and tried to enter the front porch to talk to someone. Before we realized, a pack of dogs started to approach us viciously. They were surrounding us and barking ferociously. I frantically tried calling the paragliding company, but it went straight to voicemail. I don’t know if the staff took to paragliding to escape this relentless, murderous-looking pack of dogs. There was no stick or a twig even to shoo them away. Even an atheist would instantly believe in God at this point, I suppose. We both started chanting every prayer we could collectively remember, our voices rising in a desperate, off-key crescendo. Our chanting volume soon soared to pitches even higher than the dogs' barking, a vocal shriek in peak that might have confused and slightly distracted the calamitous canines. They retracted slightly. We took that minuscule window of opportunity and jumped into our car from frailty to safety! Even if my voice couldn’t qualify for American Idol, I am sure it could for America's Got Talent!

Apart from a few yoga lessons, sprint training is high on our list for now to survive safely. Even more dogs surrounded our vehicle and would not let us move forward. I had to move extremely slowly to move the dogs from our path. They followed us for a distance and finally let us off. Our heart rates were in the peak exercise range, and we were sure we would pass any stress echocardiogram tests. It is time to amend the old saying “curiosity is the mother of invention” to “curiosity is the mother of tension in the fourth dimension.” This is probably not the age to venture into any adventure lest we end up with dentures.

An Ode to My First Guru

2025-05-10T09:54:00.001-04:00

You are my first Guru, oh Mother dear,

No other can match you, you’re always near.

The love you bestowed is a radiant star,

Resonating within me like the strings of a sitar.

When feelings were bruised

And the mind was confused

Like a gentle butterfly, you graced my brow,

Turning my low spirits into joy somehow.

When hunger pangs were gnawing away

You shared the last crumb, chasing my blues far away

My pain you'd soothe, with a smile,

That selfless love, a vast stockpile,

Removed my glum more than the crumb!

The foolish tantrum I threw,

hurting the divinity that I knew...

For denying what I didn’t deserve

Yet the soothing snuggle you sweetly serve

Was a song to calm my every nerve

You brushed away my doubts and fears

Exemplifying love, you wiped away my tears

You shaped me with your gentle grace

Worthy of everyone’s embrace

I bow to my guiding star

My beloved first Guru and superstar!

Dedicated to all mothers!

By Pradeep Alur, May 9, 2025.

If Fate had a date!

2025-01-25T14:02:00.002-05:00

When you get a premium extra legroom on a long flight, you are instantly reminded of LG's slogan, "Life is good." Well! I paid a premium to experience that prime feeling. However, when I was about to treasure that short-term pleasure, the Casio slogan reminded me, "Expect the unexpected." A baby in the backseat, as if rigidly following Harley Davidson's "American by birth, but Rebel by choice," felt envious of my pleasure in leisure and began to express it with a deafening cry. The helpless mom, trying to be considerate to others and to herself, picked her up and meandered into my cherished, premium leg space as if it was Disneyland's "Happiest place on earth (or was it on flight!). I had no choice but to retract my reveling limbs from my luxury space. The cry now transformed into a mocking smirk on that intolerant infant.

Mother, pleased with her baby's newfound happiness, decided to linger longer than an hour. This procreator and cry creator combination instantly inspired similar pairs on the flight. One after another, I began to savor the Shangri-La with my begrudging benevolence. It seemed my premium space had a Sony Playstation tag: "Live in your world, play in ours." I was made to sit and feel like McDonald's. "I'm loving it!". I could neither evade the child's charming smile nor reconcile with my aching, recoiled legs. I finally had to settle with Burger King's way: "Have it your Way!"

It was time to enjoy the joy of the ocean. As we landed on the island of seafood, vegetarians like me had sea, but not food! The resort's chef had personally handpicked several fallen leaves and decoratively arranged them on a tiny plate sprinkled with drops of dressing.

When asked if there was any other variety of vegetarian food, he promised that he would have grass the next day, perhaps coinciding with lawn mowing tonight. Having had no yummies in our tummies, we decided to venture out to see the creatures of the coral world. After forfeiting my biweekly paycheck for the entrance fees, we zoomed in to the coral park. We were then asked to buy some honey to feed the lorikeets. We gladly obliged and eagerly awaited to satiate the culinary needs of this lorikeet. None came. Environmentalists excitedly informed them that if they were not hungry, they wouldn't feed. We waited. The honey was very tempting since we had just plant leaves for lunch.

Neither birds would have it, nor we could have it. I wished we were standing at the back of the crowd to cherish the nectar, which looked like a loaf of meat for a hungry lion. Social constraints lead to extreme self-restraint.

We then proceeded to the turtle feeding. We didn't realize that they ate carrots, broccoli, etc. It seemed they had a better vegetarian menu than ours at the resort. I offered with the pretext of feeding the not-so-hungry turtles. However, the staff showed no interest, thus depriving me of the option to satisfy my growling stomach. Interestingly, I saw a couple with some enticing vegetarian snacks trying to feed the beastly looking Iguanas. Out of sheer curiosity and bare necessity, I approached the couple and asked where they got it? The naïve couple couldn't remember the place or the name, much to my chagrin. But offered the delicious dessert to me. My face gleamed, and my appetite beamed until my esteemed couple screamed, "Please, feel free to feed the iguanas." I glanced at them as gloom began to bloom and muttered: "Of course, thank you."

As we boarded our long flight back, we couldn't carry food from the airport, as it was small and had no vegetarian options, which was not surprising. We were happy to see the cheese platter on the flight menu. We asked for a platter and water, and the attendant thought it would make us fatter and gave us the latter to shatter the prospect of eating veggie matter. I asked for peanuts, and she explained to me the cost cuts.

My initial hope was great, but as fate had its date, I was left without a plate and continued my hunger state.

A Banquet on A Bluff!

2024-12-13T19:21:00.001-05:00

A Banquet on A Bluff!

It was a glorious day! Picturesque mountains, a mellifluous breeze, and my wife's melodious voice were invigorating. Our 37^th anniversary deserved this tranquil transformation from the hustle and bustle of the city. However, as the breeze from the seas began to please, my wife’s gentle squeeze reminded me that it was time to appease the appetite as well.

I enquired about decent restaurants with scenic beauty to savor. The majority recommended this dreamy diner on a bluff! I was pleased to know I didn’t need to be a climber to reach this diner. It was no bluff that this diner on the bluff was beautiful stuff! We were delicately greeted and elegantly seated.

The view was enchanting, enhanced by the soft glow of tealights. As I was enjoying the beautiful scenery at the eatery, I realized I should have been more specific in my requests. I wanted not only a feast for the eyes but also for our tummies! It had been a while, and there was no trace of the waitstaff! Were they enjoying the scenery, too, I wondered! I was unsure if the tealights had to go off for the waitress to take orders. I was glad it was not a candlelight dinner! Our hopes saw the slight light as the waitress meandered with a new tealight. We quickly voiced our choices and continued the nail-biting session.

Before we forgot what we ordered, the waitress brought us drinks. It was Vodka! We explicitly stated we preferred grains, but she got us fermented grains! She profusely apologized but kept it going. At one point, I just wanted to take the vodka and be done with it. Now, we had neither food nor mood. I was tempted to blow off the tealights to speed up the service. As it became dark, there was no more scenery to savor but to wait for the waitresses’ favor. This restaurant was very appropriately named Hunger Station-not your feeding station.

Three people brought our orders, rekindling our hopes. Placing all the plates and dishes on our tiny tealight table was challenging. Our excitement was exploding in anticipation. Visualizing our food was a chore! Not because it was plenty, but because it was scanty! The dim light did not matter, as all the portions were spoonfuls! I thought they might have dropped something on the floor while bringing it. I looked back for any spillage. There was none. I wondered if they calculated our BMIs using tealights and sized the portions accordingly. Or maybe their motto is: "Enjoy the viewing, if not the chewing!" I gradually realized why the reviews raved about the views and nothing about the chews.

The waitress turned off the tealights and handed us the bill. Maybe she was checking to ensure we didn’t get heartburn from the check, as the food was too scant to cause any. The bill made me still, and my bank balance went down the hill. Should I tip or, to save, just strip and dance? That was the dilemma. Looking at my wife, I decided against later and trepidatiously tipped. Maybe their slogan was "Hunger Station: Snack slightly, spend knightly!!"

My wife smiled and offered the handy airline candy, which served as a shandy. As we returned to our resort, we decided to stop en route to have the cake and eat it, too!

To Dye or Not To Dye

2024-07-11T18:22:00.004-04:00

To Dye or Not To Dye

"Wow! Great moves, Pradeep!" exclaimed our new acquaintance after watching my short dance. "You have a flexible body! Because of your young age, you can pull off those moves." my agonized acquaintance analyzed my performance. "I am your age, Adam," I proudly announced, further astonishing him. He stared at my paltry hair in despair after I compared my age with his. Yes, I did a good paint job, I thought, as a restrained quaint smile pervaded my freshly painted facial hair! This renewed my confidence, and I was never confused about whether to dye or not to dye.

Well, days passed—I mean, months went by—and I went for my job interview. As I explained the reason for my move—my daughter getting married and the other daughter in her Master's—we felt free to explore our ambitions. The interviewer was amazed at my actual age and adored my dexterous dye job!

As months went by, I mean years passed by, to dye or not to wasn't even a question! We went to Snoqualmie Falls near Seattle. As the guidance was given by a Ms, we were apparently misguided to the top of the falls! The walk to the bottom of the falls was steep and arduous. We saw several young, athletic men and women panting and walking up the falls! As believers of our perceived age, we both walked down to the amazing falls! That's where our confidence had an amazing fall! Walking up the steep, deep inside, we felt our actual age may overcome our perceived one. However, my painted face had a picture-perfect smile, masking my true age! To our astonishment, a middle-aged couple spotted us and unabashedly asked, "Uncle, why don't you wait here? I will get my car to take you to the upper parking lot. It will be too much to walk at your age". My wife readily agreed, as she was aware of my actual age! I immediately grabbed my phone and took a selfie! Actually, I remembered to dye! I did not miss any strands as well! Who is he then? A radiologist looking through me to diagnose my bone age? My wife insisted, and my twisted ego resisted, but her insistence persisted, and she enlisted the new aspiring radiologist's assistance. I finally consoled myself that my wife didn't dye her hair so he could predict my age.

As hours passed, it was time to head to the airport. We took a connecting train, and it was packed! I moved forward to look for any vacant seats. There were none. As I was turning back to wade through the crowd towards my wife, a middle-aged man in his fifties with flawless grey hair offered to me with the blackest hair, "Uncle, do you want a seat?" I considered asking him to take a selfie and compare it with mine. Who has black hair? Now the question is, to dye or not to dye? It may be time to change the brand, as I introspected and went ahead and changed it.

As days passed, It was time to see the biggest blockbuster-Kalki 2898 AD. After all, it was made by my close friend's son! With my wife waiting in the car, I rushed to purchase the first day's first show tickets. The middle-aged lady at the counter said, "For you, the price is $20 a ticket". I assumed she was giving me a discount based on my imposing mustache. Upon inquiry, she revealed that it was a senior citizen discount. A grand brand or no brand, is it time to disband? I had to take out my ID to prove my young age and disprove her terrible and deplorable assumption. However, I pretended I was purchasing alcohol and hence, I was proving I was above 21!

Well, to dye or not to dye-is that even question?

Sex-Specific Differences in Nutrient Intake in Late Preterm Infants

2024-05-17T11:52:00.004-04:00

Sex-Specific Differences in Nutrient Intake in Late Preterm Infants

Pradeep Alur

1,*,

Sumana Ramarao

Addie Hitt

Simmy Vig

Radha Alur

1 and

Naveed Hussain

https://www.mdpi.com/2683666

Abstract

Challenging the assumption of uniform nutritional needs in preterm feeding, this study identifies crucial sex-specific disparities in formula milk intake and growth among late preterm infants. Premature infants have difficulty regulating their oral intake during feeds, which is why clinicians prescribe feeding volume, calories, and protein via the nasogastric route. However, premature male and female infants have different body compositions at birth, and, subsequently, there is no evidence to suggest that male and female preterm infants differ in their nutritional consumption once they begin feeding ad libitum. This study investigates whether there are any differences in the volume and nutrient intake between the sexes when fed formula ad libitum. Methods: The study involved a retrospective analysis of preterm infants admitted to the NICU and evaluated between 34 0/7 and 36 6/7 weeks of corrected gestation. Late preterm infants appropriate for gestational age who were spontaneously fed formula milk ad-lib and free of any respiratory support for at least two days were included. The study excluded infants with short gut syndrome, severe chromosomal anomalies, or congenital heart conditions. We included 85 male and 85 female infants in this study. The data collected included sex, gestational age, birth weight, anthropometric data at birth, maternal data, nutritional intake, and neonatal morbidity. Results: This study found that female infants consumed more volume, protein, and calories than male infants. The mean formula intake in female and male infants was 145.5 ± 20.8 mL/kg/d and 135.3 ± 19.3 mL/kg/d, respectively, with p = 0.002. However, ad-lib feeding duration was not different between the sexes. Growth velocity was also higher in female infants. Conclusions: This study is the first to demonstrate differences in formula milk intake among late preterm infants fed ad libitum. Additional research is needed to confirm our findings and understand sex-specific differences in neonatal nutrition in extremely early preterm infants.

Association between Weight for Length and the Severity of Respiratory Morbidity in Preterm Infants

2024-05-17T11:50:00.006-04:00

https://www.mdpi.com/2635470

Association between Weight for Length and the Severity of Respiratory Morbidity in Preterm Infants

by Pradeep Alur 1,*,Kristen Harvey 2,Kyle Hart 2,Wondwosen K. Yimer 3 andRenjithkumar Kalikkot Thekkeveedu 4

Abstract

Association Between Weight for Length and the Severity of Respiratory Morbidity in Preterm Infants. Objective: To determine whether higher weight-to-length z-scores after 32 weeks of gestation are associated with higher pulmonary scores (PSs) in preterm infants requiring respiratory support using a prospective observational study. Methods: Infants born at <30 weeks, with a post-menstrual age (PMA) of 30–33 weeks, were enrolled. The infant’s weight, length, and head circumference were measured weekly. Data on calories/kg/d, protein g/kg/d, weight-for-length percentiles, z-scores, and BMI at 33 through 40 weeks PMA were collected. The PS was calculated. Results: We analyzed 91 infants. The mean gestational age was 26.9 ± 1.7 weeks. The mean birthweight was 0.898 ± 0.238 kgs. They were predominantly African American (81.3%) and girls (56%). Postnatal steroids were administered in 26.4% of the infants. The mean duration of invasive ventilation was 19.23 days ± 28.30 days. There was a significant association between the PS and W/L z-score (p < 0.0001). For every one-unit increase in W/L z-score, the PS increased by 0.063. There was a significant association between the PS and W/L percentile (p = 0.0017), as well as BMI (p ≤ 0.0001). For every unit increase in W/L percentile, the PS increased by 0.002, and for a unit increase in BMI, the PS increased by 0.04. The association remained significant after postnatal steroid use, sex, and corrected and birth gestational ages were included in the regression analysis. Nutrition did not affect the anthropometric measurements. Conclusions: Our study is the first to demonstrate that a higher BMI and W/L may adversely affect the respiratory severity in preterm infants. Studies with larger sample sizes are needed to confirm our findings.

Mother Thy Name is Love!

2024-05-11T19:10:00.003-04:00

"Mother, thy name is love."

A force to be reckoned with, recognized even by the heavens above.

In every deed, your care is woven,

In every word, love is spoken.

Dad may make you mad,

Our follies may make you sad,

Yet, you have made our smiles your only goal,

Showing love is the only way for every soul.

When life's tempests rage and roar,

A wicked display it had in store,

Your love revived the strength as never before,

And made us face the world with fear no more.

The love you have sown,

Which has grown over the years we have known,

Will there be a day, will there be a way

We can match and repay?

Mother- thy name is love!

Pradeep Alur. May 12, 2024.

2024-05-08T07:46:00.001-04:00

Happy Nurses' Week!

Lucky we are, we have nurses.

When life brings a curse

And the situation becomes adverse,

The care of a nurse is a soothing verse.

Lucky we are, we have nurses!

When hope turns to reverse,

And the options are so diverse,

And chances seem to be inverse,

A nurse- your best buddy to converse.

Lucky we are, we have nurses!

Their hearts are so tender,

The service they render,

The fears they disperse,

The patience they disburse.

Lucky we are, we have nurses!

Pradeep Alur, MD. 

May 7, 2024.

To Ditch or Switch!

2023-04-24T11:23:00.000-04:00

Health is unpredictable, so we need to save so we don't cave into the grave health expenses wave. One of the government-approved is a flexible savings account (FSA) for a fixed amount to surmount taxable amounts. Money is deducted from pretax to take care of the task of health maintenance.

Well! At this stage of the health-thwarting rage of the age, FSA takes the front stage! Though the amount is meager, I am still its eager seeker; as the adage goes-something is better than nothing. With advancing technology, we can now use a debit card from FSA for health-related purposes. My employer provides WEX to use our flex amount. Using our beloved cell phones to scan health receipts and upload them into WEX made it convenient.

So, the other day, I saw my cardiologist for a routine follow-up.

He promptly billed me for $400. My health insurance, of course, has a combustible deductible and humbly provides us with a venue to take care of this deductible in the form of a copay. The copay was $242.92. You don't need to pray to pay this copay when you have WEX as the fairway! I used my smart Android phone to scan the receipt and converted it into a pdf file in style with a smile. I uploaded the WEX receipt into my nonvexing flexible WEX!

Now comes the expect the unexpected, as Casio says! WEX responded after two days that WEX is for health-related purposes only. Though health has many physical, mental, etc. aspects, the Internal Revenue Service does not recognize SEX as part of health maintenance and hence will not allow Flex's WEX to be used for Sex! I was perplexed!

I went to a physician, not to such a vibrant technician. I again checked to see if it was addressed to me; mortifyingly, it was! The receipt did not have anything that could be confused with sex. I even verified on the dark web to see if my cardiologist's name was spelled similarly to a porn star! That was not the case either!

When I investigated further over the phone in a secluded area, as it would involve a lot of sex words, It became clear that my phone converted the WEX receipt into a sex receipt, and the file's name changed to "Sex receipt-April 20-2023.pdf". They did not even open the document as their screening software blocked it due to its file name! Hmm! Now I do not know if I should ditch my phone or switch from Flex's WEX!

Modern Technology Modulating Couple

2023-02-10T15:43:00.000-05:00

Modern Technology Modulating Couple

We are a loving couple, so we love to argue. Argument brings out the best in us in using the language. Of course, we end up explaining what that word meant or what we meant in that context. Ultimately, we apologize for the poor choice of words because we never intended that way anyway! As we learn to choose our terms wisely, we sometimes need help. We seek help from our counter-arguing spouse for the correct word.

However, after providing the apt word, he/she won’t accept that characterization, and the exchange becomes heated and animated! Though our following dramatic expressions never make it to Oscar nominations, they usually result in hoo-hah lively disagreement. However, in our case, the roof of the car opened up with our gestures! The rain was pouring outside!

Nature naturally cooled our tempers as we scrambled to find the switch to close the sliding roof. My paltry hair was vastly wet, and the makeup needed cleanup! We looked at each other and laughed loudly! The voice assistant in the car sensed we enjoyed the open roof and opened the top again! We promised each other we would not take our devotion to expressive emotions outside. Knowingly or not, the current technology dispelled dissensus and compelled consensus in us against automation. Ultimately, technology brought us closer together!

Life Energy!

2022-04-01T12:57:00.002-04:00

We say the body is the temple of God

And the heart is His altar!

In this temple resides the divine energy

And both work in perfect synergy!

None can create or destroy this energy

It is devoid of any lethargy

As it can change from one form to another!

When it energizes this mortal body

Undeniably but fleeting

We call it a being

Sleeping, breathing

Walking and talking

Laughing and loving!

We cherish everything

Seeing and unseeing!

Forget not, it is this ever-changing energy

But not this mortal physical form

Which gave us this joy and tears!

The thoughts, the memories

The moments and the madness,

All perceived of this divine energy!

Yet in times of darkness

We lose our sharpness

And just see the amalgamation of the five elements

Blended with integuments

Perceived with sentiments!

Be reminded that it is divine energy

Ever dynamic that we savored

And which is deathless and perpetual!

We the energy in this amalgam

Will continue to cherish

As We will never perish!

Pradeep Alur.

April 1, 2022.

Sex differences in preterm nutrition and growth: the evidence from human milk associated studies

2022-02-27T14:34:00.001-05:00

https://rdcu.be/cHF1l

Review Article

Published: 24 February 2022

Sex differences in preterm nutrition and growth: the evidence from human milk associated studies

Pradeep Alur & Sumana Ramarao

Journal of Perinatology (2022)

Abstract

Sexual dimorphism of the fetus manifests itself even during pregnancy. Preterm births are more common in pregnancies with male fetuses. Intrauterine and postnatal growth nomograms are sex-specific. The human milk composition in term infants appears to be sex-specific. Early nutrition has sex-specific effects and neurodevelopmental outcomes. A large same-sex twin study suggests that a mother’s own milk (MOM) provides sex-specific growth advantages probably related to the calibration of a mother’s milk based on her newborn’s sex. Formula composition does not vary with infant sex, which may be one reason why body composition data favors the use of MOM over formula. However, given the lack of data on this subject, we need more detailed information on how the sex-specific micronutrients in MOM influence infant well-being. We also need more information to ascertain the sex differences in infants’ macronutrient requirements, such as whether preterm females have higher fat requirements and preterm males have higher protein requirements for optimal growth and neurodevelopmental outcomes. This information may also influence milk banking and the use of donor human milk (DBM). Further research may help us determine if we should provide sex-specific DBM to those preterm infants who cannot get their MOM.

Our Vacation in A Great Location!

2021-08-15T22:38:00.011-04:00

Yellowstone was the cornerstone for the establishment of National Parks in America. Hence, it became my dream to visit. By August, the desire was so overgrown that it had outgrown my ability to resist, and as a result, my family was flown to this well-known Yellowstone! The spirits were ebullient, but the flight was turbulent! The flight was three and half hours from Atlanta to Jackson Hole. Do you know that Jackson Hole is not a city? Hole is the whole valley amid the majestic Tetons. The food rather tiny teeny-weeny almonds was served on the plane. Our family was not seated together. I was not sure if airlines were concerned about infighting on the flight. I also wondered if Alexa alerted the airlines! In any case, I had suspicion if my co-passenger would have opposition to my devouring of the delectable miniature snack. When he bent down to fetch his bag, I quickly gulped the nuts innocently.

We were delighted to alight the flight and then proceeded to get our rental car. When the Enterprise announced we were getting Ford-Bronco, I imagined 1994 Bronco. However, it matched the small-scale snack package we were recently treated to. Our delight declined as the air in one of the rear tires also declined. Fortunately, Enterprise gave us an immense surprise by providing us Toyota Rav-4 for the same rental price. How can we not praise the Enterprise!

Yellowstone is a beauty to behold! Different terrains in different places were delightfully engaging and enchanting. Waterfalls were amazing, and the geysers and fumaroles were alluring! Wildlife was plentiful and beautiful, but Bears were barely seen. The craving to see this carnivore was so high that anyone uttering “where” would lead to the commotion of cameras for Bears! But eventually, everyone would settle for chipmunk likeness. Bison were bountiful. The herds of bison and buffaloes were a spectacle to behold. The nonchalant behavior and majestic walk of these colossal creatures were captivating. A thin fog percolating the picturesque pastures upsurged the beauty of the background. Hordes of people would hurriedly stop to feast their eyes on these handsome herds.

Coyotes were camouflaged and often eluded the eager eyes. We were lucky to see one that was spotted by a patient enthusiast. Nevertheless, we were jubilant! Lamar Valley is acclaimed for its array of animals. Meandering through this valley was mesmerizing. We had a good peek at Pronghorns too! Several others were lucky to gaze at the grizzlies and distantly sight the wolves. I believe that the planets in our horoscopes did not align for eight straight days to enable us to see them in the wild. We went to Bear & Wolf Discovery Center in West Yellowstone town to satiate our senses. However, one of the visitors staying at our hotel used to describe how they saw several black bears with cubs and even grizzly bears. I was tempted to ask his time and date of birth to compare our horoscopes. When we expressed our intense desire to follow his route, he told us his deep desire to take a break that day! I never thought my horoscope would be so goofed up! My wife went and bought a birthstone ring for me to boost our prospects.

Every major scenic stop-over was an absolute must. However, parking was a significant issue with almost 1-2 miles away from the actual parking lot. Searching for a spot was arduous and laborious except for the handicapped spot. I was alluded to ask if falling hair and balding head qualified for such a parking slot! I quickly erased that idea after looking around and watching the bountiful bald heads!

Finally, we hiked up the Fairy Falls trail to see the gorgeous Grand Prismatic. The colors were imposingly impressive as the hot spring stood there, still giving us a lifetime thrill and killing our will to move from the hill. However, the chill on the hill made us intensely seek grand peematic on Grand Prismatic. Nature is powerful, and the call of Nature is, of course, most powerful! With speed, we reached the rest area, we were sure we would have broken the Olympic record of 1000 meters dash!

The Flowers’ Fervor

2020-08-15T22:36:00.003-04:00

The Flowers’ Fervor

Chided by the flowers adversely

the previous day for trashing them mercilessly,

I felt remorse and walked back into the garden sheepishly.

Soft aroma filled winds gently blowing

The sun tenderly kissing the buds to wake up

The blossoms began to sway to the lilting breeze!

Lord! Not sure if they were enjoying the Nature

Or saying no to this creature,

Hesitantly, I advanced,

To seek pardon, as they glanced!

With a soothing timbre

And lovely glimmer

They announced

“We are from this Nature

And hence our nature

To make one and all around us happy.

It’s our joy to see you enjoy

It’s for others that we exist

On your happiness, we subsist.

The fragrance, after you relish

Don’t trash, for us to perish.

After you savor

Be kind to us for the favor

That’s the code of the cosmos!

If nature is hurt

The power it can exert

Nothing can cope

Nothing will be left for hope.

Live in the Nature

One with the Nature!

Oh! One more thing!

For generations, we gave you bliss

Our final goal, we don’t want to miss

Take us to the Lord’s altar

Our divine destination

Our final integration!

Isn’t that your consideration?

Said the flowers with fervor.

Pradeep Alur. August 15, 2020.

Dress Wise!

2020-07-30T19:25:00.000-04:00

Dress- Wise

Oh, what a day, I pondered as I meandered the long corridor to the parking lot! I did not realize that my excitement was just beginning when I heard the fascinating ring tone of my captivating wife. She lovingly enquired about my day and touchingly added a chore without delay. "Hey, don't forget to buy a nice dress for Gomini. It is her birthday, and we are going to surprise her." Sensing possible excuse of a long day, she hit me with a sentiment, "she truly believes you are her brother." It was the moment when truth felt feeble in the face of the emotional upheaval! She concluded her charming conversation that she would text me the size and reminded me of my dexterity in dress selection. The gentle reminder of my finesse in figuring out the fabulous fabric facilitated me to forget my fatigue and browse at Belk.
The dresses were abundant, designs redundant, I was reluctant for a consultant, and yet, I was triumphant. The lady at the dress section after her inspection, commended my selection. After reaffirmation, I whistled my way to home. My attempt to show off as the doyen of dress selection was dotingly declined for lack of time. Savoring her unwavering confidence, I quickly freshened, and we drove off to Gomini's house.

As we alighted, Gomini was delighted. We hugged her and wished her a great birthday. After the exchange of pleasantries, we jovially asked what Madhav (Gomini's husband) bought for her. She very proudly displayed the gold necklace he bought with gleaming eyes. Marveling at Madhav's spousal love, Radha gently nudged me to show her the gift we purchased. Taking stalk of the situation, without much hesitation, shortening the anticipation, I began the demonstration of the culmination of my imagination.

"OMG! It's lovely! So pretty! OMG," Gomini exclaimed in sheer exhilaration. As she began to reassess the dress, tears began to express, and distress became difficult to suppress. She became emotional! We both moved close to her, and I blurted, "it's a small gift, and we are happy it complements Madhav's beautiful necklace." Gomini looked at me, and I saw a tinge of melancholy in her eyes. Her sadness vanquished my gladness. She said, "bhayya (oh brother), do I look so fat to you! I never imagined you had that impression!" It was my time to cringe and singe. How did my assignment turn into my arraignment! Radha immediately grabbed the dress, and the size startled her! She was bewildered to find it big-way big! She stared at me and the expression needed no sub captions to declare how I repeatedly screw up simple tasks!

To pacify Gomini, I said that I righteously followed her bhabi's (sister-in-law) directions. I affirmed that I never question Radha's orders but only obey them. Do or die, and never ask why! Hence, it was not my imagination of her body image but strictly sticking to the specifications. My pride as a dress connoisseur expeditiously evaporated. Radha and I took our phones out to show the text. Then Radha started laughing. Radha apparently typed 8 petite. Her iPhone had its own mind, corrected it to 8 prettier. I was positively convinced to buy a pretty dress at size 8 rather than 8p.
Gomini quickly comprehended the confusion and burst out laughing, hugging both of us. After discerning the smartness of the smartphones, embracing what we read and what it means can make a mighty difference, and how autocorrection may lead to dejection and misperception, with that introspection, I realized the conception of the gift cards.

You may not be dress-wise, but never be size-unwise to avoid surprises that may arise and that's my advice!

Nature As Our Teacher

2020-07-26T14:39:00.000-04:00

Every morning the sun rises
For eons, without compromises
Warmth he provides everyday
One cannot repay in anyway
He does without expectation
He does without invitation.

Untiringly the globe revolves
Admiringly the seasons, it provides
For the life as it evolves
Does it without remuneration
Does it without discrimination.

For others when we do a little
Without a recompense, should we belittle?
We live in this Nature
Can we learn from this Nature?
Treat Nature as our teacher!
To do a bit more
Expecting nothing more.
If that could become our nature
Peace and joy will be our daily feature!
Pradeep Alur, July 26, 2020.

Oh Mother!

2020-05-10T10:53:00.000-04:00

Oh mother! Oh mother!
Wish we can be together

You are such a soother, oh mother!
For you make any problem a feather
And cajole us to wither any weather!
The times with you, oh mother!

We immensely cherish and treasure
As you fill our minds with pleasure
And banish all our pressure
Your love, oh dear mother!

how can any mortal measure?
The Nature’s splendor is your nature, oh mother!

by
Pradeep Alur. May 10, 2020.

Corona the Heartless

2020-03-21T17:29:00.001-04:00

Corona the Heartless

Corona the heartless
Putting the world in utter distress
Is it a revenge?
That Nature arranged!

Cast or creed
Religion or region
You did not discriminate
Neither language nor age
You didn’t bother to differentiate

Country or continent
Competent or incompetent
Nothing mattered but your commitment
Celebrity or without identity
You showed the same intensity

Are you sending us a message?
Even with your wreckage
That all humans are one
And discriminate no one?

Importance is not in the handshake
but in the differences, we forsake
Though, we keep six feet apart
What matters is the good vibes we impart

From the Nature you came
to remind us to proclaim
that humans are the same
and we come from the same divine frame.

By
Pradeep Alur.
3/21/2020.

Stress and Wellbeing. Tackling the Root Cause-My Personal Journey.

2019-10-29T16:21:00.000-04:00

Oh Mother!

2019-05-12T14:18:00.003-04:00

Oh, mother the love you shower
Has the tenderness of a flower
The joy, when the life tries to devour
You stand with us like a tower
And bestow us the mental power
To tide over the maladies to ashore
When the life is an abyss
You are such a bliss
For the caressing hand that you lend
That we ultimately depend
Oh mother! You are our best friend
And most definitely the Godsend!

Pradeep Alur. May 12 2019.

What Man Proposes Bank Disposes With Bonus

2019-03-31T19:35:00.001-04:00

Whether you are married or not, it doesn’t matter. You just need money. That’s where the banks come into play. The banks are very generous; Of course, with your money. Once (decades ago) I wrote a check for $970, and my bank seemed very liberal in the payout. They extrapolated their collective view that $0 in your account has no value and added that 0 to my $970 and issued $9,700 to the already rich landlord company. Since my account did not have sufficient balance to meet their generosity, they kindly froze my account and imposed overdraft fees.

As if this is not enough of a headache for my bald head, my cellphone check that also arrived that day for clearance bounced for lack of funds. The carrier was not happier as my bank set up a barrier for me to pay the dime on time and hence put me off-line. To add salt to the injuries, my credit card check for $980 also bounced for the same reason. The credit card company tried to reach me; I believe, but alas my cellphone had no service. If the credit (card) cannot debit (your account) it will edit your score and discredit your card. I was at a gas station, and my credit card was denied. I had $11 in my wallet, which was enough to buy some chocolate but won’t be enough for filling the tank. I went into the gas station to use the ATM to withdraw, and I had the shock of my life as I had no funds, and they digitally informed that I couldn’t withdraw even one-digit currency! I was 40 miles away to buy furniture at an outlet shop on sale.

I could hardly buy 2 gallons of gas, due to my credit impasse. As a fellow in neonatology, I rarely believed in astrology but felt I should have checked out numerology at least. Moreover, It was unclear how my dear $8,000 could queerly disappear. After I reached home, I realized that cellphone service was turned off rather than lacked the signal. As it was a weekend, the bank was closed in the afternoon, and I couldn’t contact them until Monday. I had to spend the rest of the weekend trying to comprehend and talking to a friend as to what he would recommend!

When I finally reached my bank, they graciously informed me that the dot after 970 was not distinct, and hence the confusion. I asked them why did they not give 97,000 instead of being miserly with $9700 if the dot was indistinct! The teller felt terribly sorry for underpaying the landlord and called the branch manager, who read the amount written in words on the check for a long time as if English was his fifth language and placed his sympathetic hand on my shoulder to announce poignantly that the landlord should return my money. When I cornered him that it was their fault, and they should put back money in my account, he looked clueless and gently asked me from which account I was asking him to transfer the money! It appeared the bank’s generosity towards the business customers equals their atrocity towards the individual customers! After I threatened that I would inform the FBI about this bank fraud, the general manager rushed to sort things out.

It took me ten days to get things straightened out. However, in the meantime, my credit rating took a hit for failing to pay the bills on time. The bank which sank my account to blank, and shrank my credit score to tank, sent a note to thank and to rank their service as swank. I thought it was a prank!

Sex Differences in Nutrition, Growth, and Metabolism in Preterm Infants

2019-02-09T10:58:00.003-05:00

Front. Pediatr., 07 February 2019 | https://doi.org/10.3389/fped.2019.00022

Biological differences between the sexes are apparent even from the early part of the pregnancy. The crown-rump length is larger in male fetuses compared to females in the first trimester. Placentae of male and female fetuses have different protein and gene expressions, especially in adverse conditions. Even within the intrauterine milieu, the same extracellular micro RNA may show upregulation in females and downregulation in male fetuses. There appears to be a natural survival advantage for females. Maternal glucocorticoids (GC) play an important role in fetal growth and organ maturation. However, excess glucocorticoids can not only affect growth but the response may be sex-specific and probably mediated through glucocorticoid receptors (GR) in the placenta. Mild pre-eclampsia and asthma are associated with normal growth pattern in males, but in female fetuses, they are associated with a slowing of growth rate without causing IUGR probably as an adaptive response for future adverse events. Thus, female fetuses survive while male fetuses exhibit IUGR, preterm delivery and even death in the face of another adverse event. It is thought that the maternal diet may not influence growth but may influence the programming for adult disease. There is growing evidence that maternal pre-pregnancy overweight or obesity status is directly associated with a higher risk of obesity in a male child, but not in a female child, at 1 year of age. It is observed that exposure to gestational diabetes is a risk factor for childhood overweight in boys but not in girls. It is fascinating that male and female fetuses respond differently to the same intrauterine environment, and this suggests a fundamental biological variation most likely at the cellular and molecular level.