Fever

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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 36 oC to 38.30oC. 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.

Vaccination for elderly

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The best gift to your grandparents is to get them vaccinated if they have not been vaccinated earlier.

• Annual influenza or flu vaccine is recommended for all persons aged 6 months and older.

• Pneumonia vaccine should be given to all adults aged 65 years and older.

• Tetanus Toxoid should be given to all irrespective of age after every 10 years.

• A single dose of herpes zoster vaccine is recommended for adults aged 60 years and older regardless whether they have had a previous episode of herpes zoster. The vaccination begins at 60 years of age.

• Hepatitis B vaccine should be given to all if they have not been vaccinated earlier.
• All diabetics aged 60 years or older should be vaccinated for hepatitis B. This recommendation is based on increased need for associated blood glucose monitoring in long term care facilities.

• All patients with chronic liver diseases should also be given the Hepatitis B vaccine.

Do not ignore warning signals

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Often people ignore warning signals and do not address them until they fall ill, often with grave consequences. Here are certain rules that you should follow.

• Never ignore any symptom or sign, which has occurred for the first time, unexplained or unusual.

• If you run and then get exhausted, this exhaustion is understandable. But if you get up exhausted after hours of rest, this needs to be investigated.

• The first episode of acidity after the age of 40 can be a heart attack.

• Acidity usually starts in young age but if it occurs after the age of 40 years, the symptoms may indicate underlying heart disease.

• You have been getting headaches for years but if the present episode of headache is unusual, severe and unexplained, you need immediate medical attention.

• It is expected whenever you go to your doctor for a particular disease, they may warn you about the following:

o Signals for emergent attention mean to call the doctor right away.
o Symptoms for urgent attention mean to contact the doctor same day.
o Symptoms for attention mean doctor to be informed in the next visit.

• One should be able to differentiate emergent from urgent symptoms and signs. Emergency warrants medical attention within minutes.

• The window period for cardiac arrest is 10 minutes, for heart attack 3 hours, for stroke 3 hours and for stoppage of bleeding 1 hour.

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