Monday, June 15, 2020

Plague

-Yersinia pestis is a nonmotile, non-spore forming, bipolar staining Gram-negative bacillus 
-Plague is a systemic zoonosis (infections in humans acquired by contact with animals) caused by Yersinia pestis, a gram-negative bacillus 
-It is a disease of rodents transmitted to humans by flea bites 

Symptoms & Signs 
Plague occurs in three common forms: 
Bubonic plague: sudden onset of fever, chills, prostration,headache, delirium,ulcer at the site of inoculation; regional lymphadenitis with suppuration of nodes (bubo) is the initial lesion
Pneumonic plague (Black Death): Cough, dyspnea, cyanosis, hemoptysis 
Septicemic plague: hemorrhage into skin and mucous membranes, shock

Diagnosis 
Aspirate from a bubo; culture of pus, sputum and blood; serologic testing 
Cultures show bipolar staining, Gram-negative coccobaccili (short rods with rounded ends with a ‘closed safety pin’ appearance) 

Treatment 

Doxycycline, ciprofloxacin,  levofloxacin, moxifloxacin, streptomycin, gentamicin, TMP-SMX

Saturday, November 30, 2019

డబ్బుతో కొనలేనివి, డబ్బు కోసం అమ్మలేనివి: డాక్టర్ పాల్ కట్టుపల్లి సందేశం

Tuesday, November 27, 2018

Progestin Only Pills (POPs)
-Progestin-only pills (POPs) (Norethindrone in the USA and desogestrel outside of the USA) are one option for women who cannot or prefer not to use estrogen-containing contraception.
-The pills are dispensed in packs of 28 active pills, which are taken continuously.
-The progestin dose is substantially lower than the dose in any combination oral contraceptive.
-it is essential that the pill be taken at the same time each day to maximize contraceptive efficacy.
Mechanisms of Action:  thickening cervical mucus to inhibit sperm migration, suppressing ovulation, lowering the midcycle peaks of follicle-stimulating hormone and luteinizing hormone, slowing movement of an egg through the fallopian tubes, and thinning the endometrium.
-Typical failure rate: 9 percent
-Most common side effects of POPs: unscheduled bleeding, changes in menses
Contraindications:
Pregnancy
Breast Cancer
Abnormal uterine bleeding
Liver tumors, cirrhosis
Noncontraceptive benefits of POPs
lighter menstrual bleeding
reduced iron deficiency anemia
protection against endometrial cancer
reduction in risk of upper genital tract infections
-Only POP available in the United States: Norethindrone
Initiation: On the first day of menses. Use backup contraception (eg, condoms) if the patient starts POPs more than five days from the onset of menses.

Question: Can you use a POP in a patient taking lamotrigine? Yes
Combined estrogen-progestin oral contraceptives (COCs)
-Estrogen used in most COCs: Ethinyl estradiol
-Most available progestins have both progestogenic and androgenic activity
-Mechanism of action: Suppression of GnRH, pituitary gonadotropin secretion; Inhibition of the midcycle luteinizing hormone (LH) surge, preventing ovulation; making endometrium less suitable for implantation.
-Typical-use failure rate: 8 percent
-Hormonal contraception can be continued until the age of menopause (average age 50 to 51 years) in healthy, nonsmoking, normal-weight women
-COC use has been associated with increased risks of myocardial infarction, hypertension,stroke, increase risk of venous thromboembolism.
-Contraindications for COC initiation:
Migraines with aura
Age > 35 years
Smoking
Hypertension
Venous thromboembolism
Known thrombogenic mutations
Ischemic heart disease or severe valvular heart disease
History of stroke
Current breast cancer
Liver cancer or cirrhosis
Non-Contraceptive Benefits of COCs: improves abnormal uterine bleeding, premenstrual syndrome, dysmenorrhea, painful ovarian cysts, acne, hirsutism, polycystic ovary syndrome,bone density, reduces the risk of endometrial and ovarian cancer;
Don’t Get Confused: COCs and Cancer: They increase the risk for developing cervical cancer; They reduce the risk of developing ovarian and endometrial cancers. Overall, the pill is not associated with an increased risk of cancer.
Initiation: COCs can be started anytime during the cycle after excluding the pregnancy.
Quick Start method: begin taking COCs on the day she is given the prescription.
Sunday Start method: start the pill on the first Sunday after her period
-Drugs which decrease the efficacy of a COC: Phenobarbital, Phenytoin,topiramate, primidone Griseofulvin, Rifampin

-Only antibiotic proven to decrease serum ethinyl estradiol and progestin levels in women taking COCs: Rifampin

Tuesday, April 24, 2018

Hawking’s Atheism Against Einstein’s Relativity



Welcome back to Defender’s Voice. This is Paul Kattupalli. Thank you for joining us. Stephen Hawking, the world’s most famous scientist and most famous atheist passed away last month. Today let us see how his atheism was against Einstein’s General theory of relativity. More than anyone else, Albert Einstein exerted tremendous influence on our modern world. He published his Special Theory of relativity in 1905 and General Theory of Relativity in 1916. They revolutionized our view of the universe. Lord Kelvin called them ‘two small clouds’ in the otherwise blue sky of late 19th century physics. Einstein’s theories changed our conception of time, space, matter, and reality as a whole. They undermined 200 years of physics. Sadly they were also among the most misunderstood theories of science.
When I was in high school, my physics teacher used to tell us a famous joke about Einstein’s description of relativity. Allegedly this joke used to be told by Einstein when he wanted to describe his theory. “When a man sits with a pretty girl for an hour, it seems like a minute. But let him sit on a hot stove for a minute and it’s longer than any hour. That’s relativity”. An hour with a pretty girl feels like a minute, a minute over a hot stove feels like an hour. There is no evidence Einstein himself told this joke, but it is not an accurate description of relativity. Relativity is not about how we feel about time or how we feel about space. Worse, it is not about how we feel about morality. Today we have people who say, ‘Didn’t Einstein tell us everything is relative, including morality?’
English historian Paul Johnson wrote about how the misconceptions of Einstein’s theories led to relativism and moral anarchy in our modern world. In his book, Modern Times, Paul Johnson wrote “Marx, Freud, Einstein all conveyed the same message to the 1920s: the world was not what it seemed. The senses, whose empirical perceptions shaped our ideas of time and distance, right and wrong, law and justice, and the nature of man’s behavior in society, were not to be trusted. Moreover, Marxist and Freudian analysis combined to undermine, in their different ways, the highly developed sense of personal responsibility, and of duty towards a settled and objectively true moral code, which was at the center of nineteenth-century European civilization. The impression people derived from Einstein, of a universe in which all measurements of value were relative, served to confirm this vision - which both dismayed and exhilarated - of moral anarchy.”
“At the beginning of the 1920s the belief began to circulate, for the first time at a popular level, that were no longer any absolutes: of time and space, of good and evil, of knowledge, above all of value. Mistakenly but perhaps inevitably, relativity became confused with relativism”.
People mistakenly got this impression from Einstein that relativity means relativism. Relativity is not the same as relativism. They are worlds apart. In fact, Einstein wanted to call his theory of relativity a theory of invariance. There are certain invariances in our universe. The term says it all, there are certain invariances in our universe, certain constants like laws of physics and speed of light. Einstein explored the relationships between variances and invariances. Things that change and thing that do not. It’s not like everything in the universe is changing.
Space, time, motion, energy, matter, and force became types of relationships rather than absolute entities they were in Newtonian physics. They became names for relationships rather than independent entities. Everyone was amazed by these fascinating discoveries of the nature. While working on General Relativity, it was told, that whenever Einstein could not think through, he would stop and pull out his violin and play Mozart until he could reconnect to the harmony of the spheres. Einstein opened our ears to hear the mathematical music of the universe, out of the harmonious interdependence of physical entities. His General Theory of Relativity made extraordinary predictions like the Big Bang, black holes in space and the expanding universe. Those concepts have fascinated us ever since.
General Theory of Relativity also influenced our cosmology. Two thousand years ago, Aristotle believed in a universe with no beginning. Three hundred years ago, Sir Isaac Newton believed in a universe with a beginning because he believed in a Creator God. After completing his great masterpiece Principia, Newton appended it with an essay called General Scholium. In this essay, Newton praised God for his great creation. After Newton, the secularization of science in the West slowly removed God from cosmology. At the dawn of the 20th century, most cosmologists believed in a universe without a beginning. They went back to following Aristotle who argued for an eternal universe. Einstein also embraced Aristotle’s eternal cosmos rather than Newton’s finite universe.
New discoveries in astronomy would forever change our understanding of the universe. But there was lot of resistance from scientific establishment. Astronomer Fred Hoyle and his colleagues Hermann Bondi and Thomas Gold rejected the idea that the universe had a beginning. They proposed a Steady State Theory. Initially Einstein subscribed to Steady State Theory. But the ground beneath his feet started to shake. In 1917, Willem de Sitter had informed Einstein that the equations of the general theory of relativity dictate an expanding universe. Einstein did not like this outcome. He was so distressed to accept the consequences of his own theory: a Universe with a beginning. He was prepared to do anything to avoid this predicament. In fact, he even modified his gravitational equations to cancel this ‘spurious’ expansion. Later in 1920s, Russian physicist Alexander Friedman also unveiled an expanding universe based on Einstein’s theories. Then came American astronomer Edwin Hubble, who made observations and announced that universe was indeed expanding. Einstein could not ignore the evidence any more. He re-evaluated his theory and removed the modifications he inserted into his theories. When Arnold Penzias and Robert Wilson discovered the cosmic microwave background, Steady State theory further crumbled, because this background radiation indicates a hot beginning for the universe.
A series of great scientific theories and discoveries unveiled a universe with a beginning. A universe with a beginning? Atheists did not like this outcome. They did everything they could to escape this reality. After China declared itself an officially atheist nation, it also prohibited teaching the Big Bang theory. When Chinese astrophysicist Fang Lizhi talked about a universe with a beginning, the Communist Party threw tantrums because their official policy is there is no God and the universe is eternal. In his book, The Intellectual in Modern Chinese History, Timothy Cheek wrote, “In December 1972, Fang Lizhi became the first Chinese physicist to publish a research article on modern cosmology, and specifically the Big Bang theory. This highly technical article met with a furious response from leading theoretical circles of the Party. Fand and his co-authors had broken a long-standing taboo by introducing the Big Bang theory to the Chinese physics world. Insofar as the Big Bang contradicted Engels’s declaration in the nineteenth century that the universe must be infinite in space and time, Fang’s paper was tantamount to heresy against Marxism. This was because, according to Party theorists, the finite universe posited in Big Bang theory left room for a divine creator, and thus represented philosophical idealism that contradicted Engel’s canonical dialectical materialism. From 1973 until Mao’s death, the Shanghai Cultural Revolution Group under Yao Wenyuan pilloried Fang and his colleagues for promoting capitalist metaphysics.”
Why did Chinese Communists and Mao Zedong attack Big Bang theory? Why did they attack Einstein’s general relativity? Because it left room for a divine creator. It contradicted Engel’s dialectical materialism. It promoted so called capitalist metaphysics.
Off course, the atheist scientists in the West are more sophisticated than Mao Zedong and Communists. Let us see how deftly Stephen Hawking played word games with the clear implications of General Relativity and Big Bang.
In A Briefer History of Time, Stephen Hawking wrote, “In the classical theory of gravity, there are only two possible ways the universe can behave: either it has existed for an infinite time, or else it had a beginning at a singularity at some finite time in the past. For reasons we discussed earlier, we believe that the universe has not existed forever. Yet if it had a beginning, according to classical general relativity, in order to know which solution of Einstein’s equations describes our universe, we must know its initial state - that is, exactly how the universe began. God may have originally decreed the laws of nature, but it appears that He has since left the universe to evolve according to them and does not now intervene in it. How did He choose the initial state or configuration of the universe? What were the boundary conditions at the beginning of time? In classical general relativity this is a problem, because classical general relativity breaks down at the beginning of the universe”.
Later in an essay for Time magazine, Albert Einstein: TIME’s Person of the Century, Stephen Hawking wrote, “General relativity completely changed the discussion of the origin and fate of the universe. A static universe could have existed forever or could have been created in its present form at some time in the past. On the other hand, if galaxies are moving apart today, they must have been closer together in the past. About 15 billion years ago, they would all have been on top of one another and their density would have been infinite. According to the general theory, this Big Bang was the beginning of the universe and of time itself. So may be Einstein deserves to be the person of a longer period than just the past 100 years.
General relativity also predicts that time comes to a stop inside black holes, regions of space-time that are so warped that light cannot escape them. But both the beginning and the end of time are places where the equations of general relativity fall apart. Thus the theory cannot predict what should emerge from the Big Bang. Some see this as an indication of God's freedom to start the universe off any way God wanted. Others (myself included) feel that the beginning of the universe should be governed by the same laws that hold at all other times. We have made some progress toward this goal, but we don't yet have a complete understanding of the origin of the universe.”
You can see the evolution of Hawking’s ideas in cosmology. In his book, he says General relativity takes us to a universe with a beginning. God may have originally decreed the laws of nature but it appears that He has since left the universe. Later in his essay, Hawking says, ‘According to General relativity, Big Bang was the beginning of the universe and of time itself. The equations of general relativity fall apart at the Big Bang. What should emerge from Big Bang? Some say God brought this universe in the way He wanted. But I feel the laws of physics brought out this universe. You can see how Stephen Hawking was contradicting himself: General theory of relativity states the laws of physics fall apart at the big bang, but the laws of physics brought the universe out of the big bang!
In his book The Grand Design, he wrote, “Because there is a law of gravity, the universe can and will create itself out of nothing”. Hawking placed physical laws even before the creation of the universe. He enthroned these laws as the creators of the universe. This assertion also contradicts Einstein’s relativity. General Relativity says that time itself started with the beginning of the universe.
In his book Mind of God, English physicist Paul Davies wrote, “Matter, space, and time are linked in the general theory of relativity. ...If we consider the moment of infinite compression, space was infinitely shrunk. But if space is infinitely shrunk, it must literally disappear, like a balloon that shrivels to nothing. And the all-important linkage of space, time, and matter further implies that time must disappear too. There can be no time without space. Thus the material singularity is also a space-time singularity. Because all our laws of physics are formulated in terms of space and time, these laws cannot apply beyond the point at which space and time cease to exist. Hence the laws of physics must break down at the singularity….The picture that we then obtain for the origin of the universe is a remarkable one. At some finite instant in the past the universe of space, time, and matter is bounded by a space-time singularity. The coming-into-being of the universe is therefore represented not only by the abrupt appearance of matter, but of space and time as well” (Mind of God, Paul Davies)
Please note those words: Because all our laws of physics are formulated in terms of space and time, these laws cannot apply beyond the point at which space and time cease to exist. Hence the laws of physics must break down at the singularity…
You cannot strip the laws of physics from matter, space and time. But Hawking had no problem in separating the laws of physics like the law of gravity from matter, space and time. He was on a mission to remove God from the beginning of the universe. He wanted to displace God with gravity. But he was not doing science. He was carried away by his naturalism and atheism.
American astronomer and NASA scientist Robert Jastrow wrote in his book God and the Astronomers, “I am fascinated by the implications in some of the scientific developments of recent years. The essence of these developments is that the Universe had, in some sense, a beginning - that it began at a certain moment in time, and under circumstances that seem to make it impossible - not just now, but ever - to find out what force or forces brought the world into being at that moment. Was it, as the Bible says,
“Thine all powerful hand
that crates the world
out of formless matter”?
No scientist can answer that question; we can never tell whether the Prime Mover willed the world into being or the creative agent was one of the forces of physics; for the astronomical evidence proves that the Universe was created 15 billion years ago in a fiery explosion, and in the searing heat of that first moment, all the evidence needed for a scientific study of the cause of the great explosion was melted down and destroyed”
Robert Jastrow says that all the evidence needed for a scientific study of the cause of the great explosion was melted down and destroyed. But Hawking, the great fire fighter could carry the law of gravity through this fire. He ignored the fact that General Relativity takes us back to the beginning of the universe but prohibits physical laws moving beyond the point of creation.
Not every scientist embraced Hawking’s godless universe. Many great physicists like George Gamow, Georges Lemaitre, John Polkinghorne concluded that the expansion of the universe implied that the universe had a beginning in time and space consistent with the Genesis account of Bible. As a matter of fact, until modern times, almost all scientists in the Western world believed in the Genesis account: God created a universe with a beginning.
We read in Genesis chapter 1, that on Day 1 of creation, God created light, time, space and earth. God put them in a relationship with each other from the first day of creation. That is what General theory of relativity teaches us. Unknowingly, Einstein proved Genesis chapter 1. He brought us back to Biblical cosmology.
Isaac Newton wrote General Scholium praising God for this great creation. What is General Scholium? It is praising and worshiping God. That is the proper end of science? understanding the wisdom of our Creator and worshiping Him.
Have you come to the Creator? Have you come to Lord Jesus Christ? I hope you receive Jesus into your life and heart today.
Prayer: The heavens declare the glory of God. Lord Jesus, this universe reflects your glory. It is sad so many in our time are blinded by unbelief, naturalism and atheism. We pray that you open the eyes of our listeners to see you as their Creator God, Lord and Savior. In your precious name, we pray. Amen.