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Dr K K Aggarwal

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.

Poor hygiene habits may lead to typhoid

By Dr K K Aggarwal
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Typhoid fever is caused by a bacterium called Salmonella typhi, which is transmitted via ingestion of food or drink that has been 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 round the year, more cases are seen during the summer and rainy seasons.

Symptoms usually develop 1–3 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.

It 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.

Few salient facts about Typhoid fever

  1. Typhoid does not affect animals and therefore transmission is 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 persists for 3 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 (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.

OTC drug does not mean it can be taken without a doctors advice

By Dr K K Aggarwal
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An over–the–counter antacid is often used to relieve mild cases of heartburn or acid reflux. Though they are available without a doctor’s prescription they should be taken only under a doctor’s advice.

As per American Academy of Family Physicians

  1. Different types of antacids work in different ways.
  2. To manage an ulcer, an antacid may need to be taken in conjunction with an antibiotic.
  3. If one needs more calcium to help strengthen bones, prefer an antacid that contains calcium carbonate.
  4. Antacids may have minor side effects in some such as nausea, headache, diarrhea or constipation.
  5. Read the label carefully to make sure that you are not allergic to any of the ingredients.
  6. People with kidney disease may not be able to take all types of antacids.
  7. An antacid may interact with other medications. So, talk to the doctor before taking an antacid.

During Sawan, air both in the body as well as in the atmosphere gets vitiated leading to storm of rains, high tides in the ocean and movement related disorders in the body. Ayurveda describes them as vata disorders and homeopathy describes them as Psora disorders. In allopathy, in terms of physical health, it represents dyspepsia, gases, distension, constipation, tachycardia, accelerated hypertension etc. and in terms of mind, it represents instability of mind, irritableness, anger and unsteady mind. This is one reason why in Sawan, auspicious functions are not held, including marriage as a marriage requires lot of cooperation, mental understanding and a steady mind. The mind is more unstable during Sawan is also depicted by the festival Guru Purnima which also falls in Sawan month. It indicates that during Sawan, one requires supervision to tame the mind. The Nag panchami also falls around this season. Nag is a symbolic representation of ego and Nag puja indicates again taming the mind and controlling the ego. Leafy vegetables are not allowed to be eaten during this month as they precipitate Airy disorders. It is also during this month that leafy vegetables contain more worms and their eggs and are unhygienic to eat especially in a community food serving. Sawan is also the month where on every Monday Lord Shiva is worshipped. Lord Shiva represents ability to wind up jobs. The unstable mind in Sawan month does not allow one to take decisive actions. Shiv ki pooja represents that it takes efforts to wind up jobs in Sawan month. During Sawan month, Lord Vishnu is also seen lying under a Sheshnag in an ocean in an open eye meditative pose. The ocean represents the disturbed state of mind, Sheshnag indicates the need to control the ego and meditative pose of Vishnu represents the need to do pranayama and meditation in this season and also it indicates that it is very easy to get dissociated from your consciousness in this month as the ego gets easily activated during this period.

Treatment for constipation in the elderly

By Dr K K Aggarwal
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In patients over of 70 years being treated with enemas for constipation, water enemas should be used rather than sodium phosphate enemas

The commonly used treatment for constipation is sodium phosphate enemas. There is evidence that the use of sodium phosphate enemas may be associated with serious adverse events.

In a retrospective series, the use of sodium phosphate enemas in older adults for constipation was associated with complications including hypotension and volume depletion, hyperphosphatemia, hypo–or hyperkalemia, metabolic acidosis, severe hypocalcemia, renal failure and EKG changes (prolonged QT interval).