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Dr K K Aggarwal

Ten ways to ease neck pain

By Dr K K Aggarwal
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  1. Don’t stay in one position for too long
  2. Keep the computer monitor at eye level.
  3. Use the hands–free function of the phone or wear a headset.
  4. Prop your touch–screen tablet or the ipad on a pillow so that it sits at a 45° angle, instead of lying flat on your lap.
  5. Keep your prescription up to date, if you wear glasses to prevent leaning your head back to see better.
  6. Don’t use too many pillows as it can stifle your neck’s range of motion.
  7. Before you move a big wardrobe across the room, consider what it might do to your neck and back, and ask for help.
  8. Sleep well.
  9. Call your doctor if neck pain is associated with radiating pain, weakness, or numbness of an arm or leg.
  10. Also call the doctor if you have fever or weight loss associated with your neck pain, or severe pain.

Common Cold

By Dr K K Aggarwal
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  1. Common cold is a benign self–limiting syndrome caused by several viruses.
  2. It is one of the most frequent acute illnesses.
  3. The term ‘common cold’ refers to a mild upper respiratory viral illness presenting with sneezing, nasal congestion, nasal discharge, low grade fever, headache and malaise.
  4. Common cold is not the same as influenza or common sore throat, which can also involve the heart.
  5. Common cold affects a pre–school child 5–7 times in a year and adult 2–3 times in a year.
  6. It can spread by direct contact with the infected person or by indirect contact with a contaminated environmental surface.
  7. It can also spread by small particle droplets that become airborne from sneezing or coughing.
  8. It can also be transmitted via large particle droplets that typically require close contact with infected person.
  9. Most important is hand to hand transmission of the virus.
  10. Infection can also spread through circulating air in commercial airline passenger cabins.
  11. Saliva does not spread any cold.
  12. The disease is most infectious on the 2nd and 3rd day of illness.
  13. However, a person may be infectious for up to two weeks.
  14. Normal cold may last for 8–10 days.
  15. The diagnosis is based on clinical findings.
  16. Common cold can exacerbate asthma in susceptible individuals.

Typhoid fever

By Dr K K Aggarwal
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Typhoid fever is caused by a bacteria Salmonella typhi and is transmitted through the ingestion of food or drink contaminated by the feces or urine of infected people.

Flying insects feeding on feces may occasionally transfer the bacteria through poor hygiene habits and public sanitation conditions. Though the cases occur all through the year, the number is higher during the summer and rainy seasons.

Symptoms usually develop 1 to 3 weeks after exposure, and may be mild or severe. They include high fever, malaise, headache, constipation or diarrhea and enlarged spleen and liver. A healthy carrier state may follow acute illness.

Typhoid fever can be treated with antibiotics. However, resistance to common antimicrobials is widespread. Healthy carriers should be excluded from handling food.

Sanitation and hygiene are the critical measures that can be taken to prevent typhoid.

  1. Typhoid does not affect animals and therefore transmission occurs only from human to human.
  2. Typhoid can only spread in environments where human feces or urine are able to come into contact with food or drinking water.
  3. Careful food preparation and washing of hands are crucial to preventing typhoid.
  4. Typhoid fever in most cases is not fatal.
  5. Prompt treatment of the disease with antibiotics reduces the case-fatality rate to approximately 1%.
  6. When untreated, typhoid fever may persist for three weeks to a month.
  7. Resistance to common antibiotics is now common.
  8. Typhoid that is resistant to common antibiotics is known as multidrug-resistant typhoid (MDR typhoid).
  9. Ciprofloxacin resistance is an increasing problem, especially in the Indian subcontinent and Southeast Asia.
  10. Typhoid vaccine taken every three years is the best preventive approach.

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.

Tips to clinically differentiate between different types of fever

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

Flu in children

By Dr K K Aggarwal
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The classical features of uncomplicated flu in children include abrupt onset of fever headache muscle pain and malaise affected by manifestation of respiratory tract illness sore throat cough and nasal discharge But all these features may not be present in all children Flu sometimes may last for more than a week in children Ear discharge progression to asthma and pneumonia are common complications in children Complicated pneumonia may be severe and rapidly fatal especially if the bacterium is Staph During winter a diagnosis of flu should be considered in all children with fever children with fever and acute onset of respiratory illness children with fever and exhilaration of underlying chest condition children with pneumonia and children with fever of more than 100 with severe cough or sore throat Fever is present in over 95 of cases often more than 39 C Cough is present in over 77 patients Nasal discharge is present in more than 78 patients Headache is present in more than 26 patients Muscle pain is present in more than 71 patients Incubation period is 1 4 days with high transmissibility The treatment is often symptomatic Cough hygiene should be practiced.

Swine Flu is back but no panic

By Dr K K Aggarwal
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• Swine flu presents with fever of more than 1000 F with cough or sore throat in the absence of any other main cause. • The diagnosis is confirmed with a lab test using rRT/PCR technique. • Mild or uncomplicated flu is characterized by fever, cough, sore throat, nasal discharge, muscle pain, headache, chills, malaise and sometimes diarrhea and vomiting. In mild cases, there is no shortness of breath. • Progressive swine flu is characterized by the above symptoms along with chest pain, increased respiratory rate, decreased oxygen in the blood, labored breathing in children, low blood pressure, confusion, altered mental status, severe dehydration and exacerbation of underlying asthma, renal failure, diabetes, heart failure, angina or COPD. • Severe or complicated swine flu is characterized by respiratory failure, requirement of oxygen or ventilator, abnormal chest x-ray, inflammation of the brain, lowering of blood pressure to less than 60 and involvement of the heart muscle. These patients will have persistent high fever and other symptoms lasting more than three days. • Most patients will remain asthmatic with illness lasting 3-7 days. • The characteristic features are presence of chills, muscle pain and joint pain. • In the pregnant women, flu can cause more serious complications including death of fetus. • Mild cases do not require admission but progressive cases need to be admitted. • Underlying, organ disease and requirement of mechanical ventilation is the indication for admission. • Oseltamivir phosphate is the treatment of choice but it should be taken under medical supervision. It has to be given in the first 48 hours. It is given in severely low patients, pregnant women, underlying organ disease or age less than 5 years. • Flu vaccine can be given to all. It should be given to all high-risk patients. • The virus spreads through droplet infection and spreads with a person coughs, sneezes, sings or speaks. The virus can cover only a distance of 3 to 6 feet. • Stay 3 feet away from the person who is coughing. • The standard prevention is respiratory hygiene, cough etiquette and hand hygiene. • Hand washing should be performed before and after every patient contact or infectious material and before putting and after removing gloves. • Hand hygiene can be performed by washing with soap and water or with alcohol based hand drops. • If hands are visibly soiled, they should be washed with soap and water. • Patients should be placed in a private room or area. The health care staff should wear a face mask while entering the patient’s room. When leaving the room, the health care workers should remove the face mask, dispose it off and then perform hand hygiene. • Patients should wear a surgical mask and should be aware of respiratory hygiene, cough etiquette and hand hygiene. • Droplet precaution should be taken for seven days after illness onset or 24 hours after resolutions of fever and respiratory syndrome. • One should not cough in the hands, handkerchief but instead cough either in the tissue paper and dispose it off or in the side of the arm. • Swine flu causes fewer deaths than normal seasonal flu. • Hong Kong Study of H1N1 (Between April and December 2009]: Overall attack rate was 10.7 percent, case-hospitalization rate was 0.47 to 0.87 % among people aged 5 to 59 years, case-ICU rate was 7.9 cases per 100,000 infections in children aged 5 to 14 years, case-ICU rate was 75 cases per 100,000 infections in adults aged 50 and 59 years, case-fatality rate was 0.4 cases per 100,000 in children aged 5 to 14 years and case-fatality rate 26.5 cases per 100,000 in adults aged 50 to 59 years. • Case fatality is 0.4 – 26.5 cases per 100,000. That means 10 deaths would occur if one lac people gets fly. For getting 95 deaths we need almost one crore people getting infected with flu. This again means 10% of the society suffering from flu or two patients per family. Either the figure 95 is wrong or the figure number of positives deaths is wrong. • Two third of deaths occur in people with underlying chronic illness. • In seasonal flu more deaths are in people above 65 years of age and in H1N1 flu more deaths are in 50-64 years old age group.

Fever

By Dr K K Aggarwal
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Fever does not mean presence of infection. There are many situations where there is fever without infection and hence needs no antibiotics.

  • Sepsis is a clinical syndrome, which results from the dysregulation of inflammatory response to an infection. The temperature is between 36oC to 38.3oC. Heart rate is often more than 90 per minute.
  • Symptomatic inflammatory response syndrome means a clinical syndrome, which results from dysregulated inflammatory response to any infections such as inflammation of the pancreas, inflammation of the vessels, clot formations in the veins.
  • Many antibiotics can cause fever; unless they are discontinued, fever will not subside.
  • Hyperthermia is a condition with elevated body temperature but it is not called fever. Examples are exposure to heat or heat stroke and in response to anesthetic drugs and anti–psychotic drugs.
  • Hyperthermia may not respond to anti–fever drugs.
  • When fever is more than 41.5oC, it is acute hyperpyrexia.
  • Hyperpyrexia is usually seen in patients with severe infections but it may also occur in brain hemorrhage. It responds to anti–fever drugs.
  • High temperature without infection is found in condition of hyperfunctioning of the thyroid gland.
  • Recreational drugs such as Ecstasy can also cause fever without any infection.
  • Mild fever can also occur after exertion.

Fever

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , | | Comments Off on Fever

Fever does not mean presence of infection. There are many situations where there may be fever without infection and hence needs no antibiotics.

  • Sepsis is a clinical syndrome, which results from the dysregulation of inflammatory response to an infection. The temperature is between 36°C to 38.30°C. Heart rate is often more than 90 per minute.
  • Symptomatic inflammatory response syndrome means a clinical syndrome, which results from dysregulated inflammatory response to any infections such as inflammation of the pancreas, inflammation of the vessels, clot formations in the veins.
  • Many antibiotics can cause fever; unless they are discontinued, fever will not subside.
  • Hyperthermia is a condition with elevated body temperature but it is not called fever. Examples are exposure to heat or heat stroke and in response to anesthetic drugs and anti–psychotic drugs.
  • Hyperthermia may not respond to anti–fever drugs.
  • When fever is more than 41.5°C, it is acute hyperpyrexia.
  • Hyperpyrexia is usually seen in patients with severe infections but it may also occur in brain hemorrhage. It responds to anti–fever drugs.
  • High temperature without infection is found in condition of hyperfunctioning of thyroid gland.
  • Recreational drugs such as Ecstasy can also cause fever without any infection.
  • Mild fever can also occur after exertion.

Fever does not mean presence of infection. There are many situations where there may be fever without infection and hence needs no antibiotics.

  • Sepsis is a clinical syndrome, which results from the dysregulation of inflammatory response to an infection. The temperature is between 36°C to 38.30°C. Heart rate is often more than 90 per minute.
  • Symptomatic inflammatory response syndrome means a clinical syndrome, which results from dysregulated inflammatory response to any infections such as inflammation of the pancreas, inflammation of the vessels, clot formations in the veins.
  • Many antibiotics can cause fever; unless they are discontinued, fever will not subside.
  • Hyperthermia is a condition with elevated body temperature but it is not called fever. Examples are exposure to heat or heat stroke and in response to anesthetic drugs and anti–psychotic drugs.
  • Hyperthermia may not respond to anti–fever drugs.
  • When fever is more than 41.5°C, it is acute hyperpyrexia.
  • Hyperpyrexia is usually seen in patients with severe infections but it may also occur in brain hemorrhage. It responds to anti–fever drugs.
  • High temperature without infection is found in condition of hyperfunctioning of thyroid gland.
  • Recreational drugs such as Ecstasy can also cause fever without any infection.
  • Mild fever can also occur after exertion.

Fever

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on Fever

Fever does not always mean presence of infection. There are many situations where fever may occur without any infection and hence needs no antibiotics.

  • Sepsis is a clinical syndrome, which results from the dysregulation of inflammatory response to an infection. The temperature is between 36°C to 38.30°C. Heart rate is often more than 90 per minute.
  • Symptomatic inflammatory response syndrome means a clinical syndrome, which results from dysregulated inflammatory response to any infections such as inflammation of the pancreas, inflammation of the vessels, clot formations in the veins.
  • Many antibiotics can cause fever; unless they are discontinued, fever will not subside.
  • Hyperthermia is a condition with elevated body temperature but it is not called fever. Examples are exposure to heat or heat stroke and in response to anesthetic drugs and anti–psychotic drugs.
  • Hyperthermia may not respond to anti–fever drugs.
  • When fever is more than 41.5°C, it is acute hyperpyrexia.
  • Hyperpyrexia is usually seen in patients with severe infections but it may also occur in brain hemorrhage. It responds to anti–fever drugs.
  • High temperature without infection is found in condition of hyperfunctioning of the thyroid gland.
  • Recreational drugs such as Ecstasy can also cause fever without any infection.
  • Mild fever can also occur after exertion.

Fever

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on Fever

Fever does not mean presence of infection. There are many situations where there may be fever without infection and hence needs no antibiotics.

  • Sepsis is a clinical syndrome, which results from the dysregulation of inflammatory response to an infection. The temperature is between 36°C to 38.30°C. Heart rate is often more than 90 per minute.
  • Symptomatic inflammatory response syndrome means a clinical syndrome, which results from dysregulated inflammatory response to any infections such as inflammation of the pancreas, inflammation of the vessels, clot formations in the veins.
  • Many antibiotics can cause fever; unless they are discontinued, fever will not subside.
  • Hyperthermia is a condition with elevated body temperature but it is not called fever. Examples are exposure to heat or heat stroke and in response to anesthetic drugs and anti-psychotic drugs. • Hyperthermia may not respond to anti–fever drugs. • When fever is more than 41.5°C, it is acute hyperpyrexia.
  • Hyperpyrexia is usually seen in patients with severe infections but it may also occur in brain hemorrhage. It responds to anti–fever drugs.
  • High temperature without infection is found in condition of hyperfunctioning of the thyroid gland.
  • Recreational drugs such as Ecstasy can also cause fever without any infection.
  • Mild fever can also occur after exertion.

Fever

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on Fever

Fever does not mean presence of infection. There are many situations where there may be fever without infection and hence needs no antibiotics.

  • Sepsis is a clinical syndrome, which results from the dysregulation of inflammatory response to an infection. The temperature is between 36°C to 38.30°C. Heart rate is often more than 90 per minute.
  • Symptomatic inflammatory response syndrome means a clinical syndrome, which results from dysregulated inflammatory response to any infections such as inflammation of the pancreas, inflammation of the vessels, clot formations in the veins.
  • Many antibiotics can cause fever; unless they are discontinued, fever will not subside.
  • Hyperthermia is a condition with elevated body temperature but it is not called fever. Examples are exposure to heat or heat stroke and in response to anesthetic drugs and anti–psychotic drugs.
  • Hyperthermia may not respond to anti–fever drugs.
  • When fever is more than 41.5°C, it is acute hyperpyrexia.
  • Hyperpyrexia is usually seen in patients with severe infections but it may also occur in brain hemorrhage. It responds to anti–fever drugs.
  • High temperature without infection is found in condition of hyperfunctioning of the thyroid gland.
  • Recreational drugs such as Ecstasy can also cause fever without any infection.
  • Mild fever can also occur after exertion.

Fever

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on Fever

Fever does not mean presence of infection. There are many situations where there is fever without infection and hence needs no antibiotics.

  • Sepsis is a clinical syndrome, which results from the dysregulation of inflammatory response to an infection. The temperature is between 36°C to 38.30°C. Heart rate is often more than 90 per minute.
  • Symptomatic inflammatory response syndrome means a clinical syndrome, which results from dysregulated inflammatory response to any infections such as inflammation of the pancreas, inflammation of the vessels, clot formations in the veins.
  • Many antibiotics can cause fever; unless they are discontinued, fever will not subside.
  • Hyperthermia is a condition with elevated body temperature but it is not called fever. Examples are exposure to heat or heat stroke and in response to anesthetic drugs and anti–psychotic drugs.
  • Hyperthermia may not respond to anti–fever drugs.
  • When fever is more than 41.5°C, it is acute hyperpyrexia.
  • Hyperpyrexia is usually seen in patients with severe infections but it may also occur in brain hemorrhage. It responds to anti–fever drugs.
  • High temperature without infection is found in condition of hyperfunctioning of the thyroid gland.
  • Recreational drugs such as Ecstasy can also cause fever without any infection.
  • Mild fever can also occur after exertion.

Fever

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on Fever

Fever does not mean presence of infection. There are many situations where there may be fever without infection and hence needs no antibiotics.

  • Sepsis is a clinical syndrome, which results from the dysregulation of inflammatory response to an infection. The temperature is between 36°C to 38.30°C. Heart rate is often more than 90 per minute.
  • Symptomatic inflammatory response syndrome means a clinical syndrome, which results from dysregulated inflammatory response to any infections such as inflammation of the pancreas, inflammation of the vessels, clot formations in the veins.
  • Many antibiotics can cause fever; unless they are discontinued, fever will not subside.
  • Hyperthermia is a condition with elevated body temperature but it is not called fever. Examples are exposure to heat or heat stroke and in response to anesthetic drugs and anti-psychotic drugs.
  • Hyperthermia may not respond to anti–fever drugs.
  • When fever is more than 41.5°C, it is acute hyperpyrexia.
  • Hyperpyrexia is usually seen in patients with severe infections but it may also occur in brain hemorrhage. It responds to anti–fever drugs.
  • High temperature without infection is found in condition of hyperfunctioning of the thyroid gland.
  • Recreational drugs such as Ecstasy can also cause fever without any infection.
  • Mild fever can also occur after exertion.