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Dr K K Aggarwal

Diabetics should take pneumonia vaccine

By Dr K K Aggarwal
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Diabetes is associated with a 25–75% increase in the relative risk of hospitalization due to pneumonia. Hence, patients with diabetes, especially those who have had diabetes for a longer duration should be given flu and pneumococcal vaccine. It is equally important to control diabetes adequately to prevent pneumonia-related hospitalization among diabetic patients.

In the study Dr. Jette B. Kornum from Aarhus University Hospital, Aalborg and colleagues identified 34,239 individuals with a pneumonia–related hospital admission and 342,390 individuals from the general population who served as a control group. The study showed that individuals with diabetes had a 26% higher risk of pneumonia–related hospitalization compared with those without diabetes. The risk of pneumonia–related hospitalization was increased by 4.4–fold in subjects with type 1 diabetes and by 1.2–fold in those with type 2 diabetes.

The maximum risk was related to longer duration of diabetes (more than 9 years) with poor glycemic control (A1c > 9%). The risk was 37% higher in diabetics of over 9 years duration and 60% higher when the A1c was over 9% as compared to 22% higher risk when the A1c was lower than 7%.

A1c is the measure of average blood sugar of the last three months and should be kept lower than 7%.

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.

Pneumonia more risky to heart patients

By Dr K K Aggarwal
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People who are hospitalized with bacterial pneumonia are eight times more likely to suffer heart attack or other “acute coronary syndrome” within 15 days of admission than are their peers hospitalized for other conditions.

Even the patients with bacterial pneumonia are at greater risk for acute heart–related “events” in the days following admission than they are one year before or after hospitalization.

As per a research at Baylor College of Medicine in Houston, from a study which focused on 206 patients with pneumonia and 395 non–pneumonia patients, compared to control patients, pneumonia patients had 7.75–fold higher risk of suffering an acute heart–related event within 15 days of being admitted to the hospital. Overall, 10.7 percent of pneumonia patients suffered an acute coronary heart event within 15 days of hospital admission, compared with only 1.5 percent of control patients. Further analysis showed that pneumonia patients were roughly 45–times more likely to experience an acute coronary heart syndrome in the days following their admission than either one year before or after their hospital stay.