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Dr K K Aggarwal

Fever in children

By Dr K K Aggarwal
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  • Do not ignore fever in children.
  • Fever with cough and cold means viral sore throat.
  • Fever with chills and rigor may be due to malaria.
  • Fever with severe headache and pain behind the eyes may be dengue.
  • If a child has fever with urinary symptoms, the child needs further investigations.
  • Do not ignore fever with jaundice.
  • Do not give aspirin to children for fever.
  • Immediately lower the temperature if the fever is more than 104°F.
  • If fever is associated with altered behavior, then immediately contact the doctor.
  • Tepid water sponging is better than sponging with cold and ice water.
  • In heat stroke, cold water sponging can lower the temperature if anti-fever medication is not working.
  • Do not ignore if body temperature is low.
  • If body temperature is less than 95°F, immediately warm the child using blankets and other measures.
  • Paracetamol is the safest medicine for children in fever.

Clinical tips to differentiate between different types of fever

By Dr K K Aggarwal
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  1. If a patient comes with fever with chills and rigors, think of Malaria in north and filaria in Vidarbha region in India.
  2. In malaria, chills occur in the afternoon; in filaria, the chills occur in the evening.
  3. Fever with joint pains on extension is often due to Chikungunya (flexion improves the pain)
  4. Think of dengue if there is fever with itching, rash and periorbital pain.
  5. In presence of fever with single chills think of pneumonia.
  6. Fever with sore throat, no cough, no nasal discharge: Think of streptococcal sore throat, especially in the children.
  7. Fever with red angry–looking throat: Think of streptococcal sore throat
  8. Fever with red epiglottis: Think of Hemophilus infection
  9. Fever with cough and or nasal discharge: Think of common flu
  10. Fever with cough, nasal discharge, nausea and vomiting: Think of H1N1 flu
  11. Fever with toxic look, persistent fever: Look for typhoid
  12. Fever with no or low rise in pulse: Look for typhoid
  13. Fever with urinary symptoms (burning, frequency): Rule out urinary infection.
  14. Fever with high TLC (white cell count) and liver pain: Rule out liver abscess
  15. Fever with watery diarrhea, with no blood or mucous: Rule out acute gastroenteritis
  16. After the fever is over, jaundice appears: This is viral hepatitis
  17. After the fever is over, one feels very weak: Rule our dengue hemorrhagic fever.

Dengue patients don’t die of platelet deficiency

By Dr K K Aggarwal
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According to international guidelines, unless the platelet count is below 10,000/or there is spontaneous active bleeding, no platelet transfusion is required. The cause of death in dengue is capillary leakage, which causes blood deficiency in the intravascular compartment, leading to multiorgan failure. At the first instance of plasma leakage from intravascular compartment to extravascular compartment, 20 ml per kg body weight per hour of fluid replacement should be administered to the patient till the difference between upper and lower blood pressure is more than 40 mmHg or the patient passes adequate urine. Giving unnecessary platelet transfusion to the patient can harm the individual. Family doctors should remember the ‘Formula of 20’ to understand the severity of dengue. • Rise in pulse by 20 • Fall in upper blood pressure by 20 mmHg • Pulse pressure lower than 20 • Hematocrit increase by 20% • Platelet count less than 20,000 • More than 20 petechiae in the tourniquet test

Malaria, Dengue, Chikungunya and Filaria are diseases spread by mosquitoes and are totally preventable. Here are a few tips to prevent them.

By Dr K K Aggarwal
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  • Both malaria and dengue mosquitoes bite during day time.
  • It is the female mosquito which bites.
  • Dengue mosquito takes three meals in a day while malaria mosquito takes one meal in three days.
  • Malaria may infect only one person in the family but dengue will invariably infect multiple members in the family in the same day.
  • Malaria fever often presents with chills and rigors. If the fever presents together with joint and muscle pains, one should suspect Chikungunya.
  • Both dengue and malaria mosquitoes grow in fresh water collected in the house.
  • The filaria mosquito grows in dirty water.
  • There should be no collections of water inside the house for more than a week.
  • Mosquito cycle takes 7–12 days to complete. So, if any utensils or containers that store water are cleaned properly once in a week, there are no chances of mosquito breeding.
  • Mosquitoes can lay eggs in money plant pots or in water tanks on the terrace if they are not properly covered.
  • If the water pots for birds kept on terraces are not cleaned every week, then mosquitoes can lay eggs in them.
  • Some mosquitoes can lay eggs in broken tires, broken glasses or any container where water can stay for a week.
  • Using mosquito nets/repellents in the night may not prevent malaria and dengue because these mosquitoes bite during the day time.
  • Both malaria and dengue mosquitoes do not make a sound. Therefore, mosquitoes that do not produce a sound do not cause diseases.
  • Wearing full sleeves shirt and trousers can prevent mosquito bites.
  • Mosquito repellent can be helpful during the day.
  • If you suspect that you have a fever, which can be malaria or dengue, immediately report to the doctor.
  • There are no vaccines for malaria and dengue.

Malaria, Dengue, Chikungunya and Filaria are diseases spread by mosquitoes and are totally preventable. Here are a few tips:

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  • Both malaria and dengue mosquitoes bite during day time.
  • It is the female mosquito which bites.
  • Dengue mosquito takes three meals in a day while malaria mosquito takes one meal in three days.
  • Malaria may infect only one person in the family but dengue will invariably infect multiple members in the family in the same day.
  • Malaria fever often presents with chills and rigors. If the fever presents together with joint and muscle pains, one should suspect Chikungunya.
  • Both dengue and malaria mosquitoes grow in fresh water collected in the house.
  • The filaria mosquito grows in dirty water.
  • There should be no collections of water inside the house for more than a week.
  • Mosquito cycle takes 7-12 days to complete. So, if any utensil or container that stores water is cleaned properly once in a week, there are no chances of mosquito breeding.
  • Mosquitoes can lay eggs in money plant pots or in water tanks on the terrace if they are not properly covered.
  • If the water pots for birds kept on terraces are not cleaned every week, then mosquitoes can lay eggs in them.
  • Some mosquitoes can lay eggs in broken tires, broken glasses or any container where water can stay for a week.
  • Using mosquito nets/repellents in the night may not prevent malaria and dengue because these mosquitoes bite during the day time.
  • Both malaria and dengue mosquitoes do not make a sound. Therefore, mosquitoes that do not produce a sound do not cause diseases.
  • Wearing full sleeves shirt and trousers can prevent mosquito bites.
  • Mosquito repellent can be helpful during the day.
  • If you suspect that you have a fever, which can be malaria or dengue, immediately report to the doctor.
  • There are no vaccines for malaria and dengue.

 

Temp below 30 not conducive for dengue

A workshop was conducted by Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India on Health and Hygiene which was coordinated by Birla Vidya Niketan. Over 200 school teachers participated and were trained in the workshop.

Women’s conference on Impact of Climate Change on Family Health

A women’s conference on’ Impact of Climate Change on Family Health’ was organised at the Mela venue. The speakers included Dr. Sunila Garg, Prof. PSM MAMC and Dr. SN Yadav (Naturopathy and Ayurveda) and Mrs Minakshi Kushwaha Principal Birla Vidya Niketan.

Facts about dengue and climate change

1.     At around 30–32oC, vectorial capacity can increase substantially owing to a reduction in the extrinsic incubation period, despite a reduction in the vector’s survival rate.

2.     Warming above 34o C generally has a negative impact on the survival of vectors and parasites.

Laboratory experiments have demonstrated that the incubation period of dengue 2 virus in Aedes aegypti could be reduced from 12 days at 30oC to 7 days at 32–35oC.

 Over 2000 school children participate in Inter-Eco Club Competitions

Over 2000 school children participated in Inter-Eco-Club Competitions which included cartoon making, paper bag painting, creating the best out of waste, yoga and aerobics. The competitions were coordinated by Birla Vidya Niketan.

 Facts about noise pollution released

 · Everyday noise exposure, compounded over time, has an impact upon our ability to hear.

 · Excessive noise can ultimately affect the degree of the presbycusis that develops.

 · Constant exposure to loud noises can cause high frequency sensorineural hearing loss.

 · As per Occupational Safety and Health Administration, all employees who are exposed to a greater than 85 dB time-weighted average must be enrolled in a hearing conservation program and provided hearing protection.

 · Furthermore, OSHA’s standards limit employees’ exposure to noise as follows: if the time-weighted average is 90 dB (which is equivalent to the noise made by a power lawn mower), they may be exposed to that noise for 8 hours; at 95 dB only 4 hours of exposure is allowed; at 100 dB only 2 hours are allowed, and so on.

 · A short blast of loud noise also can cause severe to profound sensorineural hearing loss, pain, or hyperacusis (pain associated with loud noise). This usually involves exposure to noise greater than 120 to 155 dB. Thus, hearing protection in the form of muffs or plugs is highly recommended anytime a person is exposed to loud noise.

 Facts about smog released

 · Smog is a serious problem and is harmful to human health.

 · Ground-level ozone, sulfur dioxide, nitrogen dioxide and carbon monoxide are especially harmful for senior citizens, children, and people with heart and lung conditions such as emphysema, bronchitis and asthma.

 · It can inflame breathing passages, decrease working capacity of the lungs, cause shortness of breath, pain when inhaling deeply, wheezing and coughing.

 · Smog can irritate the eyes and nose. It dries out the protective membranes of the nose and throat and interferes with the body’s ability to fight infection, increasing susceptibility to illness.

 · Hospital admissions and respiratory deaths often increase during periods when ozone levels are high.

Seminar on ‘Looking within: Consciousness and Artificial Intelligence’ organised at the Mela

 A seminar on consciousness and artificial intelligence was organised and convened by Er Anuj Sinha, Former Director Vigyan Prasar, DST.

 Kavi Sammelan organised in Perfect Health Mela

Hindi Academy organised a Kavi Sammelan in the evening. The poets who participated included Sh. Mahendra Ajnabi, Sh. Mahendra Sharma, Shri Anand Karivardhan, Shri Deepak Gupta and Shri Ved Prakash.

Yash Chopra’s Death Should Not Cause Treatment Panic: Not All Dengue Are Serious

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The mortality of dengue is less than 1% and that too only in selected cases said Padmashri and  Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India. Dr Aggarwal said that the forthcoming MTNL perfect health mela will focus on identification, prevention and treatment of severe dengue.

There are three groups of patients who needs attention in dengue

1. Coexisting medical conditions, such as pregnancy, infancy, old age, obesity, diabetes mellitus, renal failure, and chronic hemolytic diseases, may increase the risk of severe dengue and/or complicate management. Referral for hospitalization is recommended for such patients regardless of other findings. Hospitalization should also be considered for patients who may have difficulties with outpatient follow-up or with timely self-referral should complications develop (eg, patients who live alone or who live far from a health care facility without a reliable means of transport).

2. “Alarm signs” include severe abdominal pain or tenderness, persistent vomiting, abrupt change from fever to hypothermia, mucosal bleeding, liver enlargement on physical exam, or abnormal mental status, such as disorientation.

3. Blood pressure <90/60 mmHg or fall in blood pressure by 20, Hematocrit >50 percent or rise in hematocrit by more than 20, difference between upper and lower blood pressure less than 20, evidence of bleeding other than petechiae,  true platelet count less than 20000, rise in pulse by 20

Not all dengue are serious

1. Current strains 1 and 3 are not serious

2. First attack of dengue is usually not serious

3. Dengue is not serious if one cam maintain the difference between upper and lower blood pressure more than 40

4. Dengue is not serious if one cam maintain blood volume and avoid intra vascular dehydration

Facts about dengue

• Dengue is a febrile illness that is caused by any one of four serotypes of this flavivirus (DEN-1, DEN-2, DEN-3, and DEN-4).

• It is endemic in more than 100 countries in tropical and subtropical regions of the world and causes an estimated 50 million infections annually worldwide.

• The greatest risk factor for the development of dengue hemorrhagic fever (DHF) or dengue shock syndrome is secondary infection with a different dengue serotype from the original infecting virus. Thus, severe disease occurs primarily in patients who reside in hyperendemic areas where multiple serotypes circulate simultaneously.

• Mosquito control is the most effective approach to the prevention of dengue transmission. There is no licensed vaccine available for preventing dengue.

• Patients with dengue fever should be cautioned to maintain their fluid intake to avoid dehydration and to take paracetamol as needed for fevers and myalgias. Aspirin or nonsteroidal antiinflammatory agents should generally be avoided.

• It is important to manage plasma leakage in dengue hemorrhagic fever with aggressive intravascular volume repletion to prevent or reverse hypovolemic shock. Blood transfusion is appropriate only in patients with significant bleeding. The adequacy of fluid repletion should be assessed by serial determination of hematocrit, blood pressure, pulse, and urine output.

• Prophylactic platelets transfusion has no role

• Early identification of patients at higher risk for shock and other complications of dengue is important. Patients with suspected dengue who have none of the warning signs for more severe illness and can maintain their fluid intake can be managed as outpatients, but may need daily re-evaluation.

• Duration of illness – The period of maximum risk for shock is between the third and seventh day of illness. This tends to coincide with resolution of fever. Plasma leakage generally first becomes evident between 24 hours before and 24 hours after defervescence.

Insecticide spraying does not help

1. Insecticide spraying in response to dengue outbreaks, is not highly effective against A. aegypti mosquitoes, which frequently breed inside houses.

2. Community-based approaches involving education of the population in efforts to reduce breeding sites, such as discarded tires and other containers that accumulate standing water, have shown some promise.

Treatment

1. Exclude other treatable diagnoses. Patients at risk for dengue can acquire other diseases with similar clinical features, such as malaria, typhoid fever, and leptospirosis. Symptoms in patients with dengue virus infections resolve in five to seven days.

2. Patients with dengue fever should be cautioned to maintain their intake of oral fluid to avoid dehydration. Fever and myalgias can be managed as needed with paracetamol. Aspirin or nonsteroidal antiinflammatory agents should generally be avoided because of the risk of bleeding complications and in children because of the potential risk of Reye’s syndrome.

3. Gastrointestinal bleeding or menorrhagia in patients with DHF, and occasionally in patients with dengue fever as well, can be severe enough to require blood transfusion.

4. Platelet transfusions have not been shown to be effective at preventing or controlling hemorrhage, but may be warranted only in patients with severe thrombocytopenia (<10,000/mm3) and active bleeding.

5. Prophylactic platelet transfusions in patients with severe thrombocytopenia but without active bleeding are generally not recommended

6. Administration of intravenous vitamin K1 is recommended for patients with severe liver dysfunction or prolonged prothrombin time

7. Use of a histamine H2 receptor antagonist or proton pump inhibitor is reasonable in patients with gastrointestinal bleeding, although there is no evidence of benefit.

8. Plasma leakage in DHF is important to manage with aggressive intravascular volume repletion to prevent or reverse hypovolemic shock

9. In mild cases oral rehydration may be sufficient. However, in patients with established intravascular fluid loss, intravenous fluid administration is recommended. Blood transfusion is appropriate in patients with significant bleeding; subsequent hematocrit measurements must be interpreted with caution since it is also critical to assess the adequacy of fluid repletion.

10. For patients with hypotensive shock, an initial bolus of five percent dextrose in normal saline or Ringer’s lactate (20 mL per kg of body weight) infused over 15 minutes is recommended, followed by continuous infusion (10 to 20 mL/kg per hour depending on the clinical response) until vital signs and urine output normalize. For patients who improve, the infusion rate should then be gradually reduced until it matches plasma fluid losses.

11. The adequacy of fluid repletion should be assessed by serial determination of hematocrit, blood pressure, pulse, and urine output. Patients with shock on presentation should initially have vital signs measured at least every 30 minutes and hematocrit measured every two to four hours.

12. Narrowing of the pulse pressure is an indication of hypovolemia in children even with a normal systolic blood pressure.

13. Normalization of the hematocrit is an important goal of early fluid repletion

14. Patients can develop shock for one to two days after initial fluid resuscitation, which represents the period of increased vascular permeability in DHF.

15. Most patients who present for medical attention before profound shock develops and who receive appropriate fluid therapy will recover quickly.

16. Usually no more than 48 hours of intravenous fluid therapy are required.

17. Discharge from the hospital is appropriate when patients have been afebrile for at least 24 hours and have normal oral intake, urine output, and hematocrit.

After the intense summer heat, the arrival of monsoon is a cause of much cheer, but it also brings along a whole lot diseases. Monsoon reduces the immunity of the body.

The most common diseases in the monsoon are malaria, dengue, Chikungunya, jaundice including gastrointestinal infections like typhoid and cholera. Viral infections like cold and cough also make their presence felt.

Chikungunya patients, classically, have joint pains that are relieved by flexing the limbs. Dengue, if not adequately managed, can be fatal in 1 to 4 percent of cases but chikungunya, though not fatal, can cause chronic debilitating joint pains that may last for years. Dengue management involves fluid resuscitation and not platelet resuscitation. Mortality can be reduced if enough fluids are given. The mortality period usually starts when the fever subsides. Inappropriate use of anti fever medicines can precipitate bleeding in dengue patients. Read more