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Gastroenteritis

Description:
Gastroenteritis or infectious diarrhea is a medical condition from inflammation  of the gastrointestinal tract that involves both the stomach (“gastro”-) and the small intestine (“entero”-). It causes some combination of diarrhea, vomiting, and abdominal pain and cramping. Dehydration may occur as a result.

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Gastroenteritis has been referred to as gastro, stomach bug, and stomach virus. Although unrelated to influenza, it has also been called stomach flu and gastric flu.

Globally, most cases in children are caused by rotavirus. In adults, norovirus and Campylobacter are more common. Less common causes include other bacteria (or their toxins) and parasites. Transmission may occur due to consumption of improperly prepared foods or contaminated water or via close contact with  individuals who are infectious. Prevention includes the use of fresh water, regular hand washing, and breast feeding especially in areas where sanitation is less good. The rotavirus vaccine is recommended for all children.

The key treatment is enough fluids. For mild or moderate cases, this can typically be achieved via oral rehydration solution (a combination of water, salts, and sugar). In those who are breast fed, continued breast feeding is recommended. For more severe cases, intravenous fluids from a healthcare centre may be needed. Antibiotics are generally not recommended. Gastroenteritis primarily affects children and those in the developing world. It results in about three to five billion cases and causes 1.4 million deaths a year.

Symptoms:
Gastroenteritis typically involves both diarrhea and vomiting, or less commonly, presents with only one or the other. Abdominal cramping may also be present. Symptoms usually starts 12–72 hours after contracting the infectious agent. If due to a viral agent, the condition usually resolves within one week.Some viral causes may also be associated with fever, fatigue, headache, and muscle pain. If the stool is bloody, the cause is less likely to be viral and more likely to be bacterial. Some bacterial infections may be associated with severe abdominal pain and may persist for several weeks.

Children infected with rotavirus usually make a full recovery within three to eight days. However, in poor countries treatment for severe infections is often out of reach and persistent diarrhea is common. Dehydration is a common complication of diarrhea, and a child with a significant degree of dehydration may have a prolonged capillary refill, poor skin turgor, and abnormal breathing. Repeat infections are typically seen in areas with poor sanitation, and malnutrition, stunted growth, and long-term cognitive delays can result.

Reactive arthritis occurs in 1% of people following infections with Campylobacter species, and Guillain-Barre syndrome occurs in 0.1%. Hemolytic uremic syndrome (HUS) may occur due to infection with Shiga toxin-producing Escherichia coli or Shigella species, causing low platelet counts, poor kidney function, and low red blood cell count (due to their breakdown). Children are more predisposed to getting HUS than adults. Some viral infections may produce benign  infantile seizures.

Causes:
Viruses (particularly rotavirus) and the bacteria Escherichia coli and Campylobacter species are the primary causes of gastroenteritis. There are, however, many other infectious agents that can cause this syndrome. Non-infectious causes are seen on occasion, but they are less likely than a viral or bacterial cause. Risk of infection is higher in children due to their lack of immunity and relatively poor hygiene.

Viral:-
Rotavirus, norovirus, adenovirus, and astrovirus are known to cause viral gastroenteritis. Rotavirus is the most common cause of gastroenteritis in children, and produces similar rates in both the developed and developing world. Viruses cause about 70% of episodes of infectious diarrhea in the pediatric age group.

Rotavirus is a less common cause in adults due to acquired immunity. Norovirus is the cause in about 18% of all cases. Norovirus is the leading cause of gastroenteritis among adults in America, causing greater than 90% of outbreaks. These localized epidemics typically occur when groups of people spend time in close physical proximity to each other, such as on cruise ships, in hospitals, or in restaurants. People may remain infectious even after their diarrhea has ended. Norovirus is the cause of about 10% of cases in children.

Bacterial:-
In the developed world Campylobacter jejuni is the primary cause of bacterial gastroenteritis, with half of these cases associated with exposure to poultry. In children, bacteria are the cause in about 15% of cases, with the most common types being Escherichia coli, Salmonella, Shigella, and Campylobacter  species. If food becomes contaminated with bacteria and remains at room temperature for a period of several hours, the bacteria multiply and increase the  risk of infection in those who consume the food. Some foods commonly associated with illness include raw or undercooked meat, poultry, seafood, and eggs; raw sprouts; unpasteurized milk and soft cheeses; and fruit and vegetable juices. In the developing world, especially sub-Saharan Africa and Asia, cholera is a common cause of gastroenteritis. This infection is usually transmitted by contaminated water or food.

Toxigenic Clostridium difficile is an important cause of diarrhea that occurs more often in the elderly. Infants can carry these bacteria without developing  symptoms. It is a common cause of diarrhea in those who are hospitalized and is frequently associated with antibiotic use. Staphylococcus aureus infectious  diarrhea may also occur in those who have used antibiotics. “Traveler’s diarrhea” is usually a type of bacterial gastroenteritis. Acid-suppressing medication  appears to increase the risk of significant infection after exposure to a number of organisms, including Clostridium difficile, Salmonella, and Campylobacter  species. The risk is greater in those taking proton pump inhibitors than with H2 antagonists.

Parasitic:
A number of protozoans can cause gastroenteritis – most commonly Giardia lamblia – but Entamoeba histolytica and Cryptosporidium species have also been implicated. As a group, these agents comprise about 10% of cases in children. Giardia occurs more commonly in the developing world, but this etiologic agent causes this type of illness to some degree nearly everywhere. It occurs more commonly in persons who have traveled to areas with high prevalence, children who attend day care, men who have sex with men, and following disasters.

Non-infectious:
There are a number of non-infectious causes of inflammation of the gastrointestinal tract. Some of the more common include medications (like NSAIDs), certain foods such as lactose (in those who are intolerant), and gluten (in those with celiac disease). Crohn’s disease is also a non-infection source of (often severe) gastroenteritis. Disease secondary to toxins may also occur. Some food related conditions associated with nausea, vomiting, and diarrhea include: ciguatera poisoning due to consumption of contaminated predatory fish, scombroid associated with the consumption of certain types of spoiled fish, tetrodotoxin poisoning from the consumption of puffer fish among others, and botulism typically due to improperly preserved food.

There are also some other unusual ways to get gastroenteritis:-

1.Heavy metals (arsenic, cadmium, lead, or mercury) in drinking water
2.Eating a lot of acidic foods, like citrus fruit and tomatoes
3.Toxins that might be found in certain seafood
4.Medications such as antibiotics, antacids, laxatives, and chemotherapy drugs

Transmission:
Transmission may occur via consumption of contaminated water, or when people share personal objects. In places with wet and dry seasons, water quality typically worsens during the wet season, and this correlates with the time of outbreaks. In areas of the world with four seasons, infections are more common in the winter. Bottle-feeding of babies with improperly sanitized bottles is a significant cause on a global scale.Transmission rates are also related to poor hygiene, especially among children, in crowded households, and in those with pre-existing poor nutritional status. After developing tolerance, adults may carry certain organisms without exhibiting signs or symptoms, and thus act as natural reservoirs of contagion. While some agents (such as Shigella) only occur in primates, others may occur in a wide variety of animals (such as Giardia)

Diagnosis:
Gastroenteritis is typically diagnosed clinically, based on a person’s signs and symptoms. Determining the exact cause is usually not needed as it does not alter management of the condition. However, stool cultures should be performed in those with blood in the stool, those who might have been exposed to food poisoning, and those who have recently traveled to the developing world. Diagnostic testing may also be done for surveillance. As hypoglycemia occurs in approximately 10% of infants and young children, measuring serum glucose in this population is recommended. Electrolytes and kidney function should also be checked when there is a concern about severe dehydration.

A determination of whether or not the person has dehydration is an important part of the assessment, with dehydration typically divided into mild (3–5%), moderate (6–9%), and severe (?10%) cases. In children, the most accurate signs of moderate or severe dehydration are a prolonged capillary refill, poor skin turgor, and abnormal breathing. Other useful findings (when used in combination) include sunken eyes, decreased activity, a lack of tears, and a dry mouth. A normal urinary output and oral fluid intake is reassuring. Laboratory testing is of little clinical benefit in determining the degree of dehydration.

Other potential causes of signs and symptoms that mimic those seen in gastroenteritis that need to be ruled out include appendicitis, volvulus, inflammatory bowel disease, urinary tract infections, and diabetes mellitus. Pancreatic insufficiency, short bowel syndrome, Whipple’s disease, coeliac disease, and  laxative abuse should also be considered.  The differential diagnosis can be complicated somewhat if the person exhibits only vomiting or diarrhea (rather  than both).

Appendicitis may present with vomiting, abdominal pain, and a small amount of diarrhea in up to 33% of cases.  This is in contrast to the large amount of  diarrhea that is typical of gastroenteritis. Infections of the lungs or urinary tract in children may also cause vomiting or diarrhea.  Classical diabetic  ketoacidosis (DKA) presents with abdominal pain, nausea, and vomiting, but without diarrhea.  One study found that 17% of children with DKA were initially diagnosed as having gastroenteritis.

Treatment:
Gastroenteritis is usually an acute and self-limiting disease that does not require medication in most cases.The preferred treatment in those with mild to  moderate dehydration is oral rehydration therapy (ORT). Metoclopramide and/or ondansetron, however, may be helpful in some children, and butylscopolamine is  useful in treating abdominal pain.

The primary treatment of gastroenteritis in both children and adults is rehydration. This is preferably achieved by oral rehydration therapy, although  intravenous delivery may be required if there is a decreased level of consciousness or if dehydration is severe. Oral replacement therapy products made with  complex carbohydrates (i.e. those made from wheat or rice) may be superior to those based on simple sugars. Drinks especially high in simple sugars, such as  soft drinks and fruit juices, are not recommended in children under 5 years of age as they may increase diarrhea. Plain water may be used if more specific  and effective ORT preparations are unavailable or are not palatable. A nasogastric tube can be used in young children to administer fluids if warranted.

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Dietary:
It is recommended that breast-fed infants continue to be nursed in the usual fashion, and that formula-fed infants continue their formula immediately after  rehydration with ORT. Lactose-free or lactose-reduced formulas usually are not necessary. Children should continue their usual diet during episodes of diarrhea with the exception that foods high in simple sugars should be avoided. The BRAT diet (bananas, rice, applesauce, toast and tea) is no longer  recommended, as it contains insufficient nutrients and has no benefit over normal feeding. Some probiotics have been shown to be beneficial in reducing both  the duration of illness and the frequency of stools. They may also be useful in preventing and treating antibiotic associated diarrhea.Fermented milk  products (such as yogurt) are similarly beneficial. Zinc supplementation appears to be effective in both treating and preventing diarrhea among children in  the developing world.

Antiemetics:
Antiemetic medications may be helpful for treating vomiting in children. Ondansetron has some utility, with a single dose being associated with less need for  intravenous fluids, fewer hospitalizations, and decreased vomiting.  Metoclopramide might also be helpful. However, the use of ondansetron might possibly be  linked to an increased rate of return to hospital in children. The intravenous preparation of ondansetron may be given orally if clinical judgment warrants.

Dimenhydrinate, while reducing vomiting, does not appear to have a significant clinical benefit.

Antibiotics:
Antibiotics are not usually used for gastroenteritis, although they are sometimes recommended if symptoms are particularly severe or if a susceptible bacterial cause is isolated or suspected. If antibiotics are to be employed, a macrolide (such as azithromycin) is preferred over a fluoroquinolone due to higher rates of resistance to the latter. Pseudomembranous colitis, usually caused by antibiotic use, is managed by discontinuing the causative agent and treating it with either metronidazole or vancomycin. Bacteria and protozoans that are amenable to treatment include Shigella Salmonella typhi,  and Giardia species. In those with Giardia species or Entamoeba histolytica, tinidazole treatment is recommended and superior to metronidazole. The World Health Organization (WHO) recommends the use of antibiotics in young children who have both bloody diarrhea and fever.

Antimotility agents:
Antimotility medication has a theoretical risk of causing complications, and although clinical experience has shown this to be unlikely, these drugs are bdiscouraged in people with bloody diarrhea or diarrhea that is complicated by fever. Loperamide, an opioid analogue, is commonly used for the symptomatic treatment of diarrhea. Loperamide is not recommended in children, however, as it may cross the immature blood–brain barrier and cause toxicity. Bismuth subsalicylate, an insoluble complex of trivalent bismuth and salicylate, can be used in mild to moderate cases, but salicylate toxicity is theoretically possible.

Prevention:
Lifestyle:
A supply of easily accessible uncontaminated water and good sanitation practices are important for reducing rates of infection and clinically significant gastroenteritis. Personal measures (such as hand washing) have been found to decrease incidence and prevalence rates of gastroenteritis in both the developing and developed world by as much as 30%. Alcohol-based gels may also be effective. Breastfeeding is important, especially in places with poor hygiene, as is improvement of hygiene generally. Breast milk reduces both the frequency of infections and their duration. Avoiding contaminated food or drink should also be effective.

Vaccination:
Due to both its effectiveness and safety, in 2009 the World Health Organization recommended that the rotavirus vaccine be offered to all children globally. Two commercial rotavirus vaccines exist and several more are in development. In Africa and Asia these vaccines reduced severe disease among infants  and countries that have put in place national immunization programs have seen a decline in the rates and severity of disease. This vaccine may also prevent illness in non-vaccinated children by reducing the number of circulating infections. Since 2000, the implementation of a rotavirus vaccination program in the United States has substantially decreased the number of cases of diarrhea by as much as 80 percent. The first dose of vaccine should be given to infants between 6 and 15 weeks of age. The oral cholera vaccine has been found to be 50–60% effective over 2 years.

Research:
There are a number of vaccines against gastroenteritis in development. For example, vaccines against Shigella and enterotoxigenic Escherichia coli (ETEC), two of the leading bacterial causes of gastroenteritis worldwide.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Gastroenteritis
http://www.webmd.com/digestive-disorders/gastroenteritis?print=true

Pain

Definition:
Pain is an unpleasant feeling often caused by intense or damaging stimuli, such as stubbing a toe, burning a finger, putting alcohol on a cut, and bumping the “funny bone”. The International Association for the Study of Pain‘s widely used definition states: “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

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Everyone feels pain at some point in their lives. Unfortunately, there is no machine to objectively assess pain. Physicians have to rely on what the patient says. Sensitivity to pain varies – acute pain may make a person only grit her teeth and wince whereas the same injury can produce “severe, unbearable pain” with weeping and wailing in others.

Pain forces a person to take notice of a body part they had probably taken for granted. This is particularly true of acute pain such as a toothache, sinusitis, appendicitis or urinary tract infection.

Our bodies are plentifully supplied with “nociceptors” in the skin, bones, muscles and internal organs. Noxious stimuli, (either injury or infection) activates them. They release electrical currents and biochemical agents. These travel along the nerves, up the spinal cord and eventually reach certain areas in the brain. The reaction occurs in a flash and the perception of pain is instantaneous

Pain motivates the individual to withdraw from damaging situations, to protect a damaged body part while it heals, and to avoid similar experiences in the future. Most pain resolves promptly once the painful stimulus is removed and the body has healed, but sometimes pain persists despite removal of the stimulus and apparent healing of the body; and sometimes pain arises in the absence of any detectable stimulus, damage or disease.

Symptoms:
Pain may occur with other symptoms depending on the underlying disease, disorder or condition. For instance, if your pain is due to arthritis, you may experience pain in more than one joint. Pain due to a compressed nerve in the lower back can even lead to loss of bladder control. Pain is often a major symptom of fibromyalgia, which is also characterized by fatigue and sleep problems.

Symptoms that might occur along with pain:

The range of symptoms that may occur with pain include:

*Depression
*Flu-like symptoms (fever, chills, sore throat, fatigue, headache, cough)
*Inability to concentrate
*Loss of appetite
*Muscle spasms
*Numbness
*Sleep disturbances
*Unexpected weight loss

There are certain Serious symptoms that might indicate a life-threatening condition:
In some cases, pain may occur with other symptoms that might indicate a serious or life-threatening condition, such as a heart attack. Seek immediate medical care  if you, or someone you are with, have any of these serious symptoms, with or without pain, including:

*Bleeding symptoms, such as bloody urine or bloody stools
*Change in consciousness or alertness; confusion
*Chest pain radiating to the arm, shoulder, neck or jaw
*Difficulty breathing, wheezing, or shortness of breath
*High fever (higher than 101 degrees Fahrenheit)
*Increased or decreased urine output
*Loss of bladder or bowel control
*Progressive weakness and numbness
*Redness, warmth or swelling
*Seizures
*Stiff neck and headache, with or without nausea or vomiting
*Weakness or lethargy

Causes:
Hundreds of diseases, disorders and conditions can cause pain, such as inflammatory syndromes, malignancy, trauma, and infection. In some cases, pain may be a symptom of a serious or life-threatening condition, such as a heart attack or cancer.

The experience of pain is invariably tied to emotional, psychological, and cognitive factors.

Pain can be due to a wide variety of diseases, disorders and conditions that range from a mild injury to a debilitating disease. Pain can be categorized as acute, chronic, referred, cancer, neuropathic, and visceral.

Acute pain is experienced rapidly in response to disease or injury. Acute pain serves to alert the body that something is wrong and that action should be taken, such as pulling your arm away from a flame. Acute pain often resolves within a short time once the underlying condition is treated.

Chronic pain is defined as lasting more than three months. Chronic pain often begins as acute pain that lingers beyond the natural course of healing or after steps have been taken to address the cause of pain.

Referred pain is pain that originates in one part of the body but is felt in another part of the body.

Cancer pain is due to malignancy.

Neuropathic pain is caused by damage to the nervous system and is often perceived as tingling, burning, and pins-and-needles sensations called paresthesias.

Visceral pain is caused by a problem with the internal organs, such as the liver, gallbladder, kidney, heart or lungs.

Recent studies have found that some people with chronic pain may have low levels of endorphins in their spinal fluid. Endorphins are neurochemicals, similar to opiate drugs (like morphine), that are produced in the brain and released into the body in response to pain. Endorphins act as natural pain killers. Chronic pain most often affects older adults, but it can occur at any age. Chronic pain can persist for several months to years.

Complications:
Complications associated with pain depend on the underlying disease, disorder or condition. For example, pain resulting from a degenerative condition such as multiple sclerosis can lead to inactivity and its associated complications. Fortunately, pain can often be alleviated or minimized by physical therapy, basic self-help measures, and following the treatment plan outlined by your doctor.

However, in some cases the degree and duration of your pain may become overwhelming and affect your everyday living. Research into the diagnosis and treatment of chronic pain is ongoing, so contact your health care professional for the latest information.

Over time, pain can lead to complications including:

*Absenteeism from work or school
*Dependence on prescription pain medication
*Pain that does not respond to treatment (intractable pain)
*Permanent nerve damage (due to a pinched nerve) including paralysis
*Physiological and psychological response to chronic pain
*Poor quality of life

Diagnosis:
A person’s self-report is the most reliable measure of pain, with health care professionals tending to underestimate severity.A definition of pain widely employed in nursing, emphasizing its subjective nature and the importance of believing patient reports, was introduced by Margo McCaffery in 1968: “Pain is whatever the experiencing person says it is, existing whenever he says it does”. To assess intensity, the patient may be asked to locate their pain on a scale of 0 to 10, with 0 being no pain at all, and 10 the worst pain they have ever felt. Quality can be established by having the patient complete the McGill Pain Questionnaire indicating which words best describe their pain.

As an aid to diagnosis:
Pain is a symptom of many medical conditions. Knowing the time of onset, location, intensity, pattern of occurrence (continuous, intermittent, etc.), exacerbating and relieving factors, and quality (burning, sharp, etc.) of the pain will help the examining physician to accurately diagnose the problem. For example, chest pain described as extreme heaviness may indicate myocardial infarction, while chest pain described as tearing may indicate aortic dissection.

Physiological measurement of pain:
fMRI brain scanning has been used to measure pain, giving good correlations with self-reported pain.

Hedonic adaptation:
Hedonic adaptation means that actual long-term suffering due to physical illness is often much lower than expected.

Legal awards for pain and suffering:
One area where assessments of pain are effectively required to be made is in legal awards for pain and suffering. In the Western world these are typically discretionary awards made by juries and are regarded as difficult to predict, variable and subjective, for instance in the US, UK, Australia and New Zealand.

Treatment:
Inadequate treatment of pain is widespread throughout surgical wards, intensive care units, accident and emergency departments, in general practice, in the management of all forms of chronic pain including cancer pain, and in end of life care. This neglect is extended to all ages, from neonates to the frail elderly. African and Hispanic Americans are more likely than others to suffer needlessly in the hands of a physician; and women’s pain is more likely to be undertreated than men’s.

The International Association for the Study of Pain advocates that the relief of pain should be recognized as a human right, that chronic pain should be considered a disease in its own right, and that pain medicine should have the full status of a specialty. It is a specialty only in China and Australia at this time. Elsewhere, pain medicine is a subspecialty under disciplines such as anesthesiology, physiatry, neurology, palliative medicine and psychiatry. In 2011, Human Rights Watch alerted that tens of millions of people worldwide are still denied access to inexpensive medications for severe pain.

A number of medications can be used to treat acute pain. Many of these are available OTC (over the counter). Commonly used medication is paracetemol (10 mg /kg/dose in children 500 mg per dose in adults). It can be repeated every four hours. Paracetemol helps with fever as well, so if the aches and pains are due to seasonal flu, there is rapid improvement. It also blocks the areas of the brain that recognise pain. NSAIDs (non steroidal anti inflammatory drugs) like ibuprofen (Brufen) and nalidixic acid relieve pain but do not have much effect on fever. They act by blocking prostaglandin, one of the chemicals responsible for feeling pain. Topical anti-inflammatory medications, particularly those containing capsaicin are very effective. They should be applied lightly over the painful area followed by an ice pack.

More often chronic pain is due to the various types of arthritis (rheumatoid, osteoarthritis), autoimmune diseases, gout and mechanical problems like a disc prolapse. It needs to be diagnosed correctly so that appropriate treatment can be started. The medications taken may be steroids, opiods or the coxib group of drugs.

Acute pain is usually managed with medications such as analgesics and anesthetics. Caffeine when added to pain medications provides some additional benefit. Management of chronic pain, however, is much more difficult and may require the coordinated efforts of a pain management team, which typically includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists, physician assistants, and nurse practitioners.

Sugar taken orally reduces the total crying time but not the duration of the first cry in newborns undergoing a painful procedure (a single lancing of the heel). It does not moderate the effect of pain on heart rate and a recent single study found that sugar did not significantly affect pain-related electrical activity in the brains of newborns one second after the heel lance procedure. Sweet oral liquid moderately reduces the incidence and duration of crying caused by immunization injection in children between one and twelve months of age.

The brain has to be retrained in its perception and response to pain. This can be done with a combination of physiotherapy and aerobic exercise. Judiciously used, these interventions help to reduce long-term dependence on pain medication.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.healthgrades.com/right-care/bones-joints-and-muscles/pain–symptoms
http://www.telegraphindia.com/1141229/jsp/knowhow/story_5590.jsp
http://en.wikipedia.org/wiki/Pain

Some Health Quaries & Answers

Fight that fever :
Q: I read in the newspaper that there is a lot of flu around. I am worried as I get sick every winter.

A: There is an epidemic of influenza. It is especially dangerous in the paediatric and geriatric age groups. Medication called Tamiflu is available to treat flu once it has developed. If you have been prescribed this medication, please remember to take the entire course. Ideally, it should be given twice a day for five days.

Flu can be prevented with a readily available vaccine, which needs to be taken as a single injection and provides protection for six months. Hopefully by that time the flu season will be over.

Ankle ache


Q: I twisted my ankle a year ago. After that I found that if I skid while walking, I tend to sprain it repeatedly. This is very painful.

A: There are ligaments around the ankle joint that should hold it firmly in place. Once you sprain your ankle, the ligaments become stretched and weakened. A slight slip will cause injury and pain. You need to go to a physiotherapist and learn ankle-strengthening exercises. It may make sense to wear an ankle support for a couple of months to prevent slips and strains.

Best exercise :

Q: What is the best exercise to do? There is so much conflicting advice that I am confused.

A: Ideal exercise really depends on how much time you have on your hands. Theoretically you need to do an hour of running or jogging and 20 minutes of stretching. Most people cannot spare that much time. If you are confined to a limited space and cannot go outdoors you could do the same amount of exercise using a stationary exercise cycle, rowing machine or treadmill. But, to make whatever exercise you do more efficient, increase the intensity for 6 minutes and then decrease it for 6. A slow one-hour stroll will improve your health significantly but these variations and additions will add benefit.

Sports physicians have come to the conclusion that the “Burpee” is the best exercise. It involves a squat, followed by a push-up and a leap into the air. Doing about 20 of them is ideal.

Clotty truth

Q: I am going to have cataract surgery and I am on 75mg aspirin once a day. The doctor asked me to “stop it before surgery” but did not specify for how long I should do so. Also should I take clopidogrel instead?

A: Aspirin and clopidogrel have similar actions. Both prevent platelets from sticking together and increase the time taken by blood to clot. You need to stop both for a week before surgery.

Kids and TV

Q: How much television should I allow my children to watch?

A: Television is a free baby sitter. You can place your child in front of it and have some quiet time for yourself. However, more and more studies have shown that television is detrimental for the social and cognitive brain development of the child. The rapidly flashing images deplete brain chemicals. Memory becomes poor and school performance suffers. The educative programmes and channels too have the same effect. Children learn far more from playing with their peers and having books read to them.

Hookah harm:

Q: I found a hookah bar near my college. My friends said it is smokeless tobacco and hence not harmful. Is it true?

A: Hookahs use specially treated flavoured tobacco and then pass the smoke through water. This does not do much to reduce the health risks. The cancer causing chemicals and nicotine are still present in high concentrations. Also since the smoking sessions last longer (an hour or so) the total amount of these poisonous substances inhaled may actually be proportionately greater. The risks for throat and lung cancer remain the same.

Jogging in pregnancy :

Q: Is running during pregnancy safe? Recently I read an article about a woman who completed a marathon and then delivered. But my parents worry even if I walk.

A: The marathon woman obviously was a regular runner with a well-conditioned physique. The dangers in exercising vigorously are dehydration (which will adversely affect the baby) and falls, which may result in injury. If you have not been advised to take bed-rest then try walking for a half hour in the morning and evening. It will build stamina, strengthen your leg muscles and help you have an easy delivery.

Groin pain :

Q: I have pain on the right side of my groin if I cough or sneeze. Do I need to worry?

A: You might be developing a hernia. You need to consult a surgeon.

Sources: The Telegraph ( Kolkata, India)

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‘Super Antibody’ Fights Off Flu

The first antibody which can fight all types of the influenza A virus has been discovered, researchers claim.

Experiments on flu-infected mice, published in Science Express, showed the antibody could be used as an “emergency treatment“.

It is hoped the development will lead to a “universal vaccine” – currently a new jab has to be made for each winter as viruses change.

Virologists described the finding as a “good step forward”.

Many research groups around the world are trying to develop a universal vaccine. They need to attack something common to all influenza which does not change or mutate.

It is verymuch suggested that  some people who had swine flu may develop ‘super immunity’ to other infections.

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Source : BBC News,July 29,2011

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Dehydration

Definition:
Water makes up around 75 per cent of the human body. It’s important for digestion, joint function, healthy skin and removal of waste products.
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Dehydration occurs when more fluid is lost from the body than is taken in. This causes an imbalance in important minerals, such as sodium and potassium, which are required for muscle and nerve function.

If there is a one per cent or greater loss in body weight because of fluid loss, dehydration occurs. This may be mild, moderate or severe, depending on the amount lost.

Infants and children are more susceptible to dehydration than adults because of their smaller body weights and higher turnover of water and electrolytes. The elderly and those with illnesses are also at higher risk.

Dehydration is classified as mild, moderate, or severe based on how much of the body’s fluid is lost or not replenished. When severe, dehydration is a life-threatening emergency.

Who are at Risk?
Anyone’s at risk of dehydration, but some people are more at risk than others.

•Babies and young children have relatively low body weights, making them more vulnerable to the effects of fluid loss.
•Older adults tend to eat less and may forget to eat and drink during the day. With increasing age, the body’s ability to conserve water decreases and a person’s sense of thirst becomes less acute. Illness and disability are also more common, which may make it harder to eat and drink enough.
•People with long-term medical conditions, such as kidney disease and alcoholism, are more at risk of dehydration.
•Short-term, acute health problems, such as viral infections, can result in dehydration because fever and increased sweating mean more fluid is lost from the body. Such illnesses may also make you feel less inclined to eat and drink.
•People living or working in hot climates or those who take part in sports or other strenuous physical activities are at greater risk of dehydration.

Symptoms:
The body’s initial responses to dehydration are thirst to increase water intake along with decreased urine output to try to conserve water. The urine will become concentrated and more yellow in color.

As the level of water loss increases, more symptoms can become apparent. The following are further signs and symptoms of dehydration:

•dry mouth,
•the eyes stop making tears,
•sweating may stop,
•muscle cramps,
•nausea and vomiting,
•heart palpitations, and
•lightheadedness (especially when standing).

The body tries to maintain cardiac output (the amount of blood that is pumped by the heart to the body); and if the amount of fluid in the intravascular space is decreased, the body tries to compensate for this decrease by increasing the heart rate and making blood vessels constrict to try to maintain blood pressure and blood flow to the vital organs of the body. This coping mechanism begins to fail as the level of dehydration increases.

With severe dehydration, confusion and weakness will occur as the brain and other body organs receive less blood. Finally, coma and organ failure, and death eventually will occur if the dehydration remains untreated.

Causes:
Around two-thirds of the water we need comes from drinks. Up to one-third comes from food (tomatoes, cucumber, fish and poultry are good sources). Some is also provided as a result of chemical reactions within the body.
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The average adult loses around 2.5 litres of water every day through the normal processes of breathing, sweating and waste removal. If we lose more fluid than usual this tips the balance towards dehydration.

Your body may lose too much fluids from:
•Vomiting or diarrhea
•Excessive urine output, such as with uncontrolled diabetes or diuretic use
•Excessive sweating (for example, from exercise)
•Fever

You might not drink enough fluids because of:
•Nausea
•Loss of appetite due to illness
•Sore throat or mouth sores

Dehydration in sick children is often a combination of both — refusing to eat or drink anything while also losing fluid from vomiting, diarrhea, or fever.

Lifestyle factors such as drinking too much alcohol, exercise, being in a hot environment or being too busy to drink liquid can also lead to dehydration.

Diagnosis:
Dehydration is often a clinical diagnosis. Aside from diagnosing the reason for dehydration, the health care practitioner’s examination of the patient will assess the level of dehydration. Initial evaluations may include:

•Mental status tests to evaluate whether the patient is awake, alert, and oriented. Infants and children may appear listless and have whiny cries and decreased muscle tone.

•Vital signs may include postural readings (blood pressure and pulse rate are taken lying down and standing). With dehydration, the pulse rate may increase and the blood pressure may drop because the intravascular space is depleted of fluid. People taking beta blocker medications for high blood pressure, heart disease, or other indications, occasionally lose the ability to increase their heart rate as a compensation mechanism since these medications block the adrenaline receptors in the body.

•Temperature may be measured to assess fever.

•Skin may be checked to see if sweat is present and to assess the degree of elasticity (turgor). As dehydration progresses, the skin loses its water content and becomes less elastic.

•Infants may have additional evaluations performed, including checking for a soft spot on the skull (sunken fontanelle), assessing the suck mechanism, muscle tone, or loss of sweat in the armpits and groin. All are signs of potential significant dehydration.

•Pediatric patients are often weighed during routine child visits, thus a body weight measurement may be helpful in assessing how much water has been lost with the acute illness.

Laboratory testing:-
The purpose of blood tests is to assess potential electrolyte abnormalities (especially sodium levels) associated with the dehydration. Tests may or may not be done on the patient depending upon the underlying cause of dehydration, the severity of illness, and the health care practitioner’s assessment of their needs.

Urinalysis may be done to determine urine concentration – the more concentrated the urine, the more dehydrated the patient.

Treatment:-
As is often the case in medicine, prevention is the important first step in the treatment of dehydration. (Please see the home treatment and prevention sections.)

Fluid replacement is the treatment for dehydration. This may be attempted by replacing fluid by mouth, but if this fails, intravenous fluid (IV) may be required. Should oral rehydration be attempted, frequent small amounts of clear fluids should be used.

Clear fluids include:
•water,
•clear broths,
•popsicles,
•Jell-O, and
•other replacement fluids that may contain electrolytes (Pedialyte, Gatorade, Powerade, etc.)
Decisions about the use of intravenous fluids depend upon the health care practitioner’s assessment of the extent of dehydration and the ability for the patient to recover from the underlying cause.

The success of the rehydration therapy can be monitored by urine output. When the body is dry, the kidneys try to hold on to as much fluid as possible, urine output is decreased, and the urine itself is concentrated. As treatment occurs, the kidneys sense the increased amount of fluid, and urine output increases.

Medications may be used to treat underlying illnesses and to control fever, vomiting, or diarrhea.

Home Treatment:
Dehydration occurs over time. If it can be recognized in its earliest stages, and if its cause can be addressed, home treatment may be beneficial and adequate.

Steps a person can take at home to prevent severe dehydration include:

•Individuals with vomiting and diarrhea can try to alter their diet and use medications to control symptoms to minimize water loss. Clear fluids often recommended as the diet of choice for the first 24 hours, with gradual progression to a BRAT diet (bananas, rice, apples, toast) and then adding more foods as tolerated.
•Loperamide (Imodium) may be considered to control diarrhea.
•Acetaminophen or ibuprofen may be used to control fever.
•Fluid replacements may be attempted by small, frequent amounts of clear fluids (see clear fluids information in previous section). The amount of fluid required to maintain hydration depends upon the individual’s weight. The average adult needs between 2 and 3 liters of fluid per day.
If the person becomes confused or lethargic; if there is persistent, uncontrolled fever, vomiting, or diarrhea; or if there are any other specific concerns, then medical care should be accessed.

Prevention:-
•Environment: Dehydration due to the weather is a preventable condition. If possible, activities should not be scheduled in the heat of the day. If they are, adequate fluids should be available, and cooler, shaded areas should be used if possible. Of course, people should be monitored to make certain they are safe. Those working in hot environments need to take care to rehydrate often.
•Exercise: People exercising in a hot environment need to drink adequate amounts of water.
•Age: The young and elderly are most at risk. During heat waves, attempts should be made to check on the elderly in their homes. During the Chicago heat wave of 1995, more than 600 people died in their homes from heat exposure.
•Heat related conditions: Know the signs and symptoms of heat cramps, heat rash, heat exhaustion, and heat stroke. Preventing dehydration is one step to avoid these conditions.

Carefully monitor someone who is ill, especially an infant, child, or older adult. If you believe that dehydration is developing, consult a doctor before the person becomes moderately or severely dehydrated. Begin fluid replacement as soon as vomiting and diarrhea start — DO NOT wait for signs of dehydration.

Always encourage the person to drink during an illness, and remember that a person’s fluid needs are greater when that person has fever, vomiting, or diarrhea. The easiest signs to monitor are urine output (there should be frequent wet diapers or trips to the bathroom), saliva in the mouth, and tears when crying.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/dehydration1.shtml
http://www.medicinenet.com/dehydration/page4.htm
http://www.nlm.nih.gov/medlineplus/ency/article/000982.htm

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