PATIENT EDUCATION

Family Planning Guidance-What all couples should know






Surviving Heart Attack-Time is money-Do not waste it. Do not wait doctor to visit your home. Take action,Talk to your doctor,call an ambulance.

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IMMUNIZATION PROTECTS ALL OF US: Don’t Wait. Vaccinate!
In the United States, vaccines have greatly reduced infectious diseases that once routinely killed or harmed many infants, children, and adults. However, the viruses and bacteria that cause vaccine-preventable disease still exist and can be passed on to people who are not protected by vaccines. Every year, thousands of Americans still suffer serious health problems, are hospitalized, and even die from diseases that could be prevented by vaccines. Protect your health and the health of your family. Make sure you and your loved ones are up-to-date on recommended vaccines.
Here’s why you shouldn’t wait:
·         Many vaccine-preventablediseases are still common in the U.S.
·         Those that are not common here are still found in other parts of the world, and can still be a threat.
·         Some of these diseases are very contagious.
·         Any of these diseases could be serious – even for healthy people.
·         Certain people may be at higher risk for getting some diseases or having more serious illness if they were to get sick, like young children, older adults, and those with health conditions.

Vaccines are our best protection against a number of serious, and sometimes deadly, diseases.Every year, the Centers for Disease Control and Prevention (CDC) and other medical experts update vaccine recommendations for children, teens, and adults based on the latest research and evidence-based science on vaccine safety, effectiveness, and patterns of vaccine-preventable diseases.

You have the power to protect yourself and the ones you love. Talk to your healthcare professional about which vaccines are right for you and your family.

Getting Vaccinated
Most private health insurance plans cover the cost of recommended vaccines. The Vaccines for Children (VFC) Program helps provide vaccines to children whose parents or guardians may not be able to afford them. Medicare and Medicaid also cover a number of vaccines for adults. Vaccines are available at private doctor offices, as well as other convenient locations such as pharmacies, workplaces, community health clinics, and health departments.

To learn more about vaccines and take a quick quiz to find out which vaccines you may need, visit: www.cdc.gov/vaccines/adults




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Prevention of Kidney Diseases
Kidney diseases are silent killers. They may cause progressive loss of kidney function leading to kidney failure and ultimately require dialysis or kidney transplant to live healthy life. Because of high cost and problems of availability, in developing countries, only 5 -10% of kidney failure patients get treatment like dialysis and kidney transplant, while the rest die without getting any definitive therapy. Chronic kidney disease is very common and has no cure, so prevention is the only option. Early detection and treatment can often keep chronic kidney disease from getting worse, and can prevent or delay the need for dialysis or a transplant.
How to prevent kidney diseases?
Never ignore your kidneys. Important aspects about prevention and care of the kidney diseases are discussed in two categories. 1. Precautions for healthy persons. 2. Precautions for kidney patients.
Precautions for Healthy Person
Seven effective ways to keep the kidney healthy are:
1. Be fit and active
Regular exercise and daily physical activity maintains normal blood pressure and controls blood sugar. Such physical activities cut the risk of diabetes and hypertension and thus reduce the risk of chronic kidney disease.
2. Balanced diet
Eat healthy diet, full of fresh fruits and vegetables. Decrease intake
of refined foods, sugar, fat and meat in diet. Less salt after 40 years of age will help in prevention of high blood pressure and kidney stones.

3. Keep your weight in check

Maintain your weight with a balance of healthy food and proper exercise. This can help in preventing diabetes, heart disease and other conditions associated with chronic kidney disease.

4. Give up smoking and tobacco products

Smoking can lead to atherosclerosis, which reduces blood flow to the kidneys, thus decrease their ability to function at their best.

5. Beware of OTCs

Don’t overuse over-the-counter painkillers on a regular basis. Common drugs such as non-steroidal anti-inflammatory drugs like ibuprofen are known to cause kidney damage and kidney failure if taken regularly. Consult a doctor to find a way to control your pain without putting your kidneys at risk.

6. Drink lots of water

Drinking sufficient water (about 3 liters per day) helps to dilute urine, eliminate all the toxic waste from the body and prevent kidney stones.

7. Annual kidney check-up

Kidney diseases are often silent diseases and do not produce any symptoms until they reach an advanced stage. The most powerful and effective but, sadly, underutilized method for early diagnosis and prevention of kidney disease is a regular kidney check-up. Annual kidney check-up is a must for high risk persons who suffer from diabetes, high blood pressure, obesity or have a history of kidney disease in the family. If you love your kidneys (and, more importantly, yourself), do not forget to get a regular kidney checkup after the age of 40. Simple method for early detection of kidney disease is an annual blood pressure measurement, urine test and a test to measure creatinine in blood.

(Article courtasy:http://kidneyinenglish.com)


Routine Screening test for kidney
Weight
Blood Pressure
Blood Sugar
Serum creatinine
Blood urea nitrogen
Urine microalbumin
Albumin to creatinine ratio

eGfr(Doctor will calculate)
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Exercise
Benefits of Exercise:
v Exercise controls weight
v Exercise combats health conditions and diseases
v Exercise improves mood
v Exercise boosts energy
v Exercise promotes better sleep
v Exercise puts the spark back into your sex life
v Exercise can be fun
Important Myths & Facts:
Myth: Exercise can only be done in morning.
Fact: Exercise is preferable in cool and calm atmosphere at any hour of the day. Mornings are preferable but any time when your stomach is empty you can do exercise. Evening or late evening also.
Myth: Domestic work or routine day to day work is enough exercise and there is no need for more.
Fact:  Domestic work or routine day to day exercise in never enough and considered as regular exercise in any way. Though they do burn extra calories, regular exercise is must.  Whenever you do your routine work it is not a continuous process so you do not burn proper calories.
Myth:  No special cloth or footwear is required while doing exercise.
Fact: Exercise should be done with good fitting clothes on and clothes which allows proper ventilation like cotton etc. Proper footwear while walking or running is must. Otherwise the ill fitting or improper footwear can lead to injury to joints of leg while doing exercise.
Myth: Walking after a major meal is an exercise.
Fact: Walking after a major meal in evening is good for digestive purpose, as it enhances secretion of digestive juices but moderate or heavy exercises after a major meal have harmful effects.
Myth: Walking is the wholesome exercise and nothing else is needed.
Fact: Walking is good but not enough. One must be doing some other exercise like muscle strengthening and stretching exercise at least 2-3 days in a week. No single form of exercise is enough.
Myth: I am too young or too old to exercise, I do not need exercise.
Fact: Exercise is good for any age and in fact must for all. At all ages there is definite advantage of doing exercise. Early initiation of exercise at younger age is important as it helps cultivating good habit for lifetime.

Important points to remember while doing exercise:


v Do not talk while doing exercise.
v After doing exercise you should be feel somewhat exhausted, this means that you have given some strain to your body and really done something.
v Maintenance of proper hydration during and after exercise is must and important.
v Exercise may feel boring in the beginning, but once you are regular you will love to do it. You can do exercise in groups which will make it more fun. Light music is always good.
v For most of the people 150 minutes of exercise /week is recommended.
v The single exercise is complete. You need to variety of exercise for full benefits.
v For senior citizens and heart patients: please avoid doing walking or any form of exercise early in the morning during winter. There are chances of heart vessels spasm and problem like angina or heart attack. Please delay your exercise schedule in winter.

Types of Exercise:
There are four kinds of exercise:
1. Physical exercise which is a part of living one's life
2. Aerobic exercise
3. Resistance training
4. Stretching
Physical Exercise:
v Walking, moving, and lifting inherent in just moving through one's daily schedule.
v One typically must walk everywhere.
v Stairs need to be climbed.
       Aerobic Exercise:
v fast walking,
v jogging,
v riding a bicycle,
v swimming,
v playing basketball
Resistance Training:
v Definition: Resistance training refers to lifting or pushing against something heavy or difficult to move.
v Benefits: Resistance training builds physical strength. It also converts fat into muscle. Muscle burns more calories.
v Types: Lifting weights, doing push-ups, sit-ups, and pull-ups.
v How to do? All major muscle groups should be involved.
v How much? Resistance training can be done three or more times per week but should be done at least twice a week.
Stretching:
v Stretching exercises help to loosen the joints and promote the free flow blood and other body fluids over the channels and connecting vessels.
v They strengthen the tendons and ligaments and also indirectly strengthen the bones.
v stretching exercises help promote mental and physical relaxation
v When? Stretching exercises are easiest to do in the late afternoon or early evening
v How :One should stretch little by little, day by day, making haste slowly
Disadvantes of Not Doing Exercise:
v softening of the bones and tendons,
v lack of energy,
v poor appetite,
v lassitude,
v Obesity and shortness of breath on exertion.
v exacerbates anxiety, irritability
v Depression.
v And lot more…….

This is written by Dr.Pragnesh M.Vachharajani
Family physician and life style disease consultant.

Important Note:(The details given here are for general information only. Please consult your doctor before starting any exercise programme.)

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Breast carcinoma is one of the common carcinomas among women.
By following methods like self breast examination, periodic mammography etc, most of the breast cancers can be detected early.
Self breast examination is a easy and important measure to detect breast cancer early.
Self breast examination should be done monthly at same period of menstrual cycle preferably after completion of menstrual cycle.
This is to avoid mistakes due to hormonal influenced breast changes.
Woman should do self breast examination by standing in front of mirror. She should use the pads of her fingers to palpate the breast tissue.

First she should observe her breast in positions:
-Arms hanging beside the body
-Arms behind the head
-Arms keeping on waist and bending forward.
-Palpation of breast in circular movements or in longitudinal movements or in wedge pattern.
Breast tissue should be palate upto axillary tail.
-Palpation of nipple
-Palpation of breast and nipple in lying down position.

    Article taken from blog of Dr. Sreegouri Sr

Worked at Sri Padmavathi medical college
Attended ZPH School

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 Rabies

Key facts

  • Rabies occurs in more than 150 countries and territories.
  • More than 55 000 people die of rabies every year mostly in Asia and Africa.
  • 40% of people who are bitten by suspect rabid animals are children under 15 years of age.
  • Dogs are the source of the vast majority of human rabies deaths.
  • Wound cleansing and immunization within a few hours after contact with a suspect rabid animal can prevent the onset of rabies and death.
  • Every year, more than 15 million people worldwide receive a post-exposure vaccination to prevent the disease– this is estimated to prevent hundreds of thousands of rabies deaths annually.

Rabies is a zoonotic disease (a disease that is transmitted to humans from animals) that is caused by a virus. The disease affects domestic and wild animals, and is spread to people through close contact with infectious material, usually saliva, via bites or scratches.
Rabies is present on all continents with the exception of Antartica, but more than 95% of human deaths occur in Asia and Africa. Once symptoms of the disease develop, rabies is nearly always fatal.
Rabies is a neglected disease of poor and vulnerable populations whose deaths are rarely reported. It occurs mainly in remote rural communities where measures to prevent dog to human transmission have not been implemented. Under-reporting of rabies also prevents mobilization of resources from the international community for the elimination of human dog-mediated rabies.

Symptoms

The incubation period for rabies is typically 1–3 months, but may vary from <1 week to >1 year. The initial symptoms of rabies are fever and often pain or an unusual or unexplained tingling, pricking or burning sensation (paraesthesia) at the wound site.
As the virus spreads through the central nervous system, progressive, fatal inflammation of the brain and spinal cord develops.
Two forms of the disease can follow. People with furious rabies exhibit signs of hyperactivity, excited behaviour, hydrophobia and sometimes aerophobia. After a few days, death occurs by cardio-respiratory arrest.
Paralytic rabies accounts for about 30% of the total number of human cases. This form of rabies runs a less dramatic and usually longer course than the furious form. The muscles gradually become paralyzed, starting at the site of the bite or scratch. A coma slowly develops, and eventually death occurs. The paralytic form of rabies is often misdiagnosed, contributing to the under-reporting of the disease.

Diagnosis

No tests are available to diagnose rabies infection in humans before the onset of clinical disease, and unless the rabies-specific signs of hydrophobia or aerophobia are present, the clinical diagnosis may be difficult. Human rabies can be confirmed intra-vitam and post mortem by various diagnostic techniques aimed at detecting whole virus, viral antigens or nucleic acids in infected tissues (brain, skin, urine or saliva).

Transmission

People are usually infected following a deep bite or scratch by an infected animal. Dogs are the main host and transmitter of rabies. They are the source of infection in all of the estimated 50 000 human rabies deaths annually in Asia and Africa.
Bats are the source of most human rabies deaths in the United States of America and Canada. Bat rabies has also recently emerged as a public health threat in Australia, Latin America and western Europe. However, in these regions the number of human deaths due to bat rabies remains small compared to those following dog bites. Human deaths following exposure to foxes, raccoons, skunks, jackals, mongooses and other wild carnivore host species are very rare.
Transmission can also occur when infectious material – usually saliva – comes into direct contact with human mucosa or fresh skin wounds. Human-to-human transmission by bite is theoretically possible but has never been confirmed.
Rarely, rabies may be contracted by inhalation of virus-containing aerosol or via transplantation of an infected organ. Ingestion of raw meat or other tissues from animals infected with rabies is not a source of human infection.

Post-exposure prophylaxis (PEP)

Post-exposure prophylaxis (PEP) consists of:
  • local treatment of the wound, initiated as soon as possible after exposure;
  • a course of potent and effective rabies vaccine that meets WHO recommendations; and
  • the administration of rabies immunoglobulin, if indicated.
Effective treatment soon after exposure to rabies can prevent the onset of symptoms and death.
Local treatment of the wound
Removing the rabies virus at the site of the infection by chemical or physical means is an effective means of protection. Therefore, prompt local treatment of all bite wounds and scratches that may be contaminated with rabies virus is important. Recommended first-aid procedures include immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances that kill the rabies virus.
Recommended PEP
PEP depends on the type of contact with the suspected rabid animal (see table).

Table: Categories of contact and recommended post-exposure prophylaxis (PEP)









Categories of contact with suspect rabid animal
Post-exposure prophylaxis measures




Category I – touching or feeding animals, licks on intact skin
None




Category II – nibbling of uncovered skin, minor scratches or abrasions without bleeding
Immediate vaccination and local treatment of the wound




Category III – single or multiple transdermal bites or scratches, licks on broken skin; contamination of mucous membrane with saliva from licks, contacts with bats.
Immediate vaccination and administration of rabies immunoglobulin; local treatment of the wound




All category II and III exposures assessed as carrying a risk of developing rabies require PEP. This risk is increased if:
  • the biting mammal is a known rabies reservoir or vector species;
  • the animal looks sick or has an abnormal behaviour;
  • a wound or mucous membrane was contaminated by the animal’s saliva;
  • the bite was unprovoked; and
  • the animal has not been vaccinated.
In developing countries, the vaccination status of the suspected animal alone should not be considered when deciding whether to initiate prophylaxis or not.

Who is most at risk?

Dog rabies potentially threatens over 3 billion people in Asia and Africa. People most at risk live in rural areas where human vaccines and immunoglobulin are not readily available or accessible.
Poor people are at a higher risk, as the average cost of rabies post-exposure prophylaxis after contact with a suspected rabid animal is US$ 40 in Africa and US$ 49 in Asia, where the average daily income is about US$ 1–2 per person.
Although all age groups are susceptible, rabies is most common in children aged under 15. On average 40 % of post-exposure prophylaxis regimens are given to children aged 5–14 years, and the majority are male.
Anyone in continual, frequent or increased danger of exposure to rabies virus – either by nature of their residence or occupation – is also at risk. Travellers with extensive outdoor exposure in rural, high-risk areas where immediate access to appropriate medical care may be limited should be considered at risk regardless of the duration of their stay. Children living in or visiting rabies-affected areas are at particular risk.

Prevention

Eliminating rabies in dogs
Rabies is a vaccine-preventable disease. The most cost-effective strategy for preventing rabies in people is by eliminating rabies in dogs through vaccination. Vaccination of animals (mostly dogs) has reduced the number of human (and animal) rabies cases in several countries, particularly in Latin America. However, recent increases in human rabies deaths in parts of Africa, Asia and Latin America suggest that rabies is re-emerging as a serious public health issue.
Preventing human rabies through control of domestic dog rabies is a realistic goal for large parts of Africa and Asia, and is justified financially by the future savings of discontinuing post-exposure prophylaxis for people.
Preventive immunization in people
Safe, effective vaccines can be used for pre-exposure immunization. This is recommended for travellers spending a lot of time outdoors, especially in rural areas, involved in activities such as bicycling, camping, or hiking as well as for long-term travellers and expatriates living in areas with a significant risk of exposure. Pre-exposure immunization is also recommended for people in certain high-risk occupations such as laboratory workers dealing with live rabies virus and other rabies-related viruses (lyssaviruses), and people involved in any activities that might bring them professionally or otherwise into direct contact with bats, carnivores, and other mammals in rabies-affected areas. As children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites, their immunization could be considered if living in or visiting high risk areas.

WHO response

For at least three decades WHO has fought to break the "cycle of neglect" affecting rabies prevention and control particularly in low- and middle-income countries through advocacy, surveys and studies and research on the use of new tools .
The Organization continues to promote human rabies prevention through the elimination of rabies in dogs as well as a wider use of the intradermal route for PEP which reduces volume and thereby cost of cell-cultured vaccine by 60 to 80%.
WHO supports targets for elimination of human and dog rabies in all Latin American countries by 2015 and of human rabies transmitted by dogs in South-East Asia by 2020. In this latter region a five-year plan (2012–2016) aims to halve the currently estimated number of human rabies deaths in endemic countries.
Fact Sheet on Non-Communicable or chronic diseases
Non-communicable - or chronic - diseases are diseases of long duration and generally slow progression. The four main types of non-communicable diseases are cardiovascular diseases (like heart attacks and stroke), cancer, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes.
Non-communicable diseases, or NCDs, are by far the leading cause of death in the world, representing 63% of all annual deaths. Non-communicable diseases (NCDs) kill more than 36 million people each year. Some 80% of all NCD deaths occur in low- and middle-income countries.

NCDs account for 63% of all deaths.

Non-communicable diseases (NCDs), primarily cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, are responsible for 63% of all deaths worldwide (36 million out 57 million global deaths).

80% of NCDs deaths occur in low- and middle-income countries.

More than 9 million of all deaths attributed to NCDs occur before the age of 60.

Around the world, NCDs affect women and men almost equally.

NCDs are largely preventable.

Noncommunicable diseases are preventable through effective interventions that tackle shared risk factors, namely: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol.

NCDs are not only a health problem but a development challenge as well.

Noncommunicable diseases force many people into, or entrench them in poverty due to catastrophic expenditures for treatment. They also have a large impact on undercutting productivity.

1.5 billion adults, 20 and older, were overweight in 2008.

Nearly 43 million children under 5 years old were overweight in 2010.

Tobacco use kills nearly 6 million people a year.

By 2020, this number will increase to 7.5 million, accounting for 10% of all deaths.

Eliminating major risks could prevent most NCDs.

If the major risk factors for noncommunicable diseases were eliminated, at around three-quarters of heart disease, stroke and type 2 diabetes would be prevented; and 40% of cancer would be prevented.


Thank you, 
DISTRICT SURVEILLANCE UNIT,
DISTRICT PANCHAYAT AHMEDABAD.
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સ્વાઇન ફલુના લક્ષણો :
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- H1N1 વાયરસથી આ રોગ ફેલાય છે.
- શરૂઆતમાં શરદી, ઉધરસ, તાવ આવે છે. જેમાં ગળામાં બળતરા થાય છે. એક બે દિવસમાં શ્વાસોશ્વાસમાં બહુ સમસ્યા થાય છે. શ્વાસ ચઢવા લાગે છે.
- એક જ મિનિટમાં ૪૦-પ૦ કરતા પણ વધુ વખત શ્વાસોશ્વાસની પ્રક્રિયા થવા લાગે છે.
- ઓકિસજનનુ પ્રમાણ ઘટી જાય છે. શ્વાસ લેવામાં તકલીફ પડવા લાગે છે.

સ્વાઇન ફલુથી બચવાના ઉપાયો
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- શરદી-તાવની સમસ્યા બહુ વધે તે પહેલા જ તબીબી તપાસ કરાવવી જોઇએ ખાસ કરીને શંકાસ્પદ કેસોમાં ગળામાંથી કલ્ચર લઇને લેબોરેટરી માટે મોકલવા જોઇએ.
- સારવાર માટે ઓસેલ્ટામીવીર ડ્રગ્ઝ (ટેમીફલુ) લેવી જોઇએ. જરૂર પડયે વેન્ટીલેટર પર મુકવા જોઇએ. આ રોગથી બચી શકાય છે.
- જાહેરમાં શરદી, કફના ગળફા ન કાઢો. ભીડભાડવાળી જગ્યામાં જવાનુ ટાળો
- સ્વાઇન ફલુથી બચવા માટે ટ૯પ માસ્ક શ્રેષ્ઠ ઉપાય છે


 

Vitamin B12 Deficiency

Vitamin B12 has many important functions in the body. It works with the B vitamin folate to make our body's genetic material. It helps keep levels of the amino acid homocysteine in check, which may help decrease heart disease risk, and it is essential to the production of red blood cells, which carry oxygen through the blood to the body's tissues.
But many people are deficient in this important vitamin

Causes of Vitamin B12 Deficiency

Vitamin B12 deficiency can have a number of possible causes. Typically it occurs in people whose digestive systems do not adequately absorb the vitamin from the foods they eat. This can be caused by:
  • Pernicious anemia, a condition in which there is a lack of a protein called intrinsic factor. The protein, which is made in the stomach, is necessary for vitamin B12 absorption.
  • Atrophic gastritis, a thinning of the stomach lining that affects up to 30% of people aged 50 and older.
  • Surgery in which part of the stomach and/or small intestine is removed.
  • Conditions affecting the small intestine, such as Crohn's disease, celiac disease, bacterial growth, or a parasite.
  • Excessive alcohol consumption.
  • Autoimmune disorders, such as Graves' disease or systemic lupus erythematosus
  • Long-term use of acid-reducing drugs.
Vitamin B12 deficiency can also occur in vegetarians, because the best food sources of the vitamin are animal products. Strict vegans (people who don't eat any animal products, including meat, eggs, or milk) are at greatest risk. Vegetarians who eat eggs and milk products are also at risk, because, on average, they consume less than half the adult Recommended Dietary Allowance (RDA) of vitamin B12.
Babies born to mothers who are vegetarians may also be deficient in vitamin B12.

Symptoms of Vitamin B12 Deficiency

A deficiency of vitamin B12 can lead to vitamin B12 deficiency anemia. A mild deficiency may cause only mild, if any, symptoms. But as the anemia worsens it may causes symptoms such as:
  • weakness, tiredness or light-headedness  
  • rapid heartbeat and breathing
  • pale skin
  • sore tongue
  • easy bruising or bleeding, including bleeding gums
  • stomach upset and weight loss
  • diarrhea or constipation
If the deficiency is not corrected, it can damage the nerve cells. If this happens, vitamin B12 deficiency effects may include:
  • tingling or numbness in fingers and toes
  • difficulty walking
  • mood changes or depression
  • memory loss, disorientation, and dementia
B12 deficiency in infants, if not detected and treated, can lead to severe and permanent damage to the nervous system. New mothers who follow a vegetarian diet should have their babies' B12 levels checked by a doctor.

Treatment for Vitamin B12 Deficiency

Vitamin B12 deficiency treatment depends on the cause of the deficiency. If pernicious anemia or a problem with absorption is the cause, B12 replacement will be necessary. Most often this is given by injection; some people may be prescribed vitamin tablets.
For some people, B12 supplementation may be necessary for life. If a diet lacking in animal products is the cause, the doctor will recommend dietary changes along with supplementation of vitamin B12 by injection or tablet.
For most people, treatment resolves the anemia; however, any nerve damage that has occurred as a result of the deficiency could be permanent.

Preventing Deficiency Problems

Most people can prevent vitamin B12 deficiency by consuming enough meat, poultry, seafood, milk, cheese, and eggs. If you don't eat animal products or you have a medical condition that limits your absorption of nutrients, experts recommend taking a B12-containing multivitamin and eating breakfast cereal fortified with vitamin B12.
If you experience symptoms of B12 deficiency, speak to your doctor about a blood test to check B12 levels.

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Immunisation Schedule 

Age Vaccines Note
Birth BCG
OPV zero
Hepatitis B -1
6 weeks OPV-1 + IPV-1 / OPV -1 OPV alone if IPV cannot be given
DTPw-1 / DTPa -1
Hepatitis B -2
Hib -1
10 weeks OPV-2 + IPV-2 / OPV-2 OPV alone if IPV cannot be given
DTPw-2 / DTPa -2
Hib -2
14 weeks OPV-3 + IPV-3 / OPV -3 OPV alone if IPV cannot be given
DTPw-3 / DTPa -3
Hepatitis B -3 Third dose of Hepatitis B can be given at 6 months of age
Hib -3
9 months Measles
15-18 months OPV-4 + IPV-B1 / OPV -4 OPV alone if IPV cannot be given
DTPw booster -1 or DTPa booster -1
Hib booster
MMR -1
2 years Typhoid Revaccination every 3-4 years
5 years OPV -5
DTPw booster -2 or DTPa booster -2
MMR -2 The second dose of MMR vaccine can be given at any time 8 weeks after the first dose
10 years Tdap
HPV Only girls, three doses at 0, 1-2 and 6 months

Vaccines that can be given after discussion with parents
More than 6 weeks Pneumococcal conjugate 3 primary doses at 6, 10, and 14 weeks, followed by a booster at 15-18 months
More than 6 weeks Rotaviral vaccines (2/3 doses (depending on brand) at 4-8 weeks interval
After 15 months Varicella Age less than 13 years: one dose
Age more than 13 years: 2 doses at 4-8 weeks interval
After 18 months Hepatitis A 2 doses at 6-12 months interval


  1. The IAP endorses the continued use of whole cell pertussis vaccine because of its proven efficacy and safety. Acellular pertussis vaccines may undoubtedly have fewer side-effects (like fever, local reactions at injection site and irritability), but this minor advantage does not justify the inordinate cost involved in the routine use of this vaccine.
     
  2. If the mother is known to be HBsAg negative, HB vaccine can be given along with DTP at 6, 10, 14 weeks/ 6 months. If the mother's HBsAg status is not known, it is advisable to start vaccination soon after birth to prevent perinatal transmission of the disease. If the mother is HBsAg positive (and especially HBeAg positive), the baby should be given Hepatitis B Immune Globulin (HBIG) within 24 hours of birth, along with HB vaccine.
     
  3. Varicella, Hepatitis A and Pneumococcal Conjugate vaccines should be offered only after one to one discussion with parents. Also refer to the individual vaccines notes for recommendations.
     
  4. Combination vaccines can be used to decrease the number of pricks being given to the baby and to decrease the number of clinic visits. The manufacturer's instructions should be followed strictly whenever "mixing" vaccines in the same syringe prior to injection.
     
  5. At present, the only typhoid vaccine available in our country is the Vi polysaccharide vaccine. Revaccination may be carried out every 3- 4 years.
     
  6. Under special circumstances (e.g. epidemics), measles vaccine may be given earlier than 9 months followed by MMR at 12-15 months.
     
  7. During pregnancy, the interval between the two doses of TT should be at least one month.
     
  8. We should continue to use OPV till we achieve polio eradication in India. IPV can be used additionally for individual protection.
     
  9. OPV must be given to children less than 5 years of age at the time of each supplementary immunisation activity.
   
  1. FAQ About Renal Calculus
  2. What are Renal Calculi?
    Kidney Stones are also termed as Renal Calculi. (Nephrolithiasis) A kidney stone is a hard, crystalline material formed within the kidney or urinary tract.

  3. What is the prevalence of renal calculi?
    Renal stone disease is common, with a worldwide prevalence of between 2 and 20%. Lifetime prevalence is nearly 10% in men and 5% in women. Approximately 50 percent of patients with previous urinary calculi have a recurrence within 10 years.

  4. What are the risk factors for renal calculi?
    • Dietary risk factors associated with increased stone risk:
    • Low fluid intake, High intake of animal protein, High dietary sodium, Excessive intake of refined sugars, Foods rich in oxalate, High intake of grapefruit juice, apple juice and soft cola drinks.
    • Family history of kidney stones (increase risk by three times)
    • History of hypertension
    • Obesity
    • Various other medical conditions.

  5. Which is the most common type of renal calculi?
    Calcium oxalate (alone or in combination) is the most common type of urinary stone.

  6. How is Renal Calculi diagnosed?
    • Pain – classic colicky loin to groin pain or renal pain
    • Haematuria, gross or microscopic
    • Dysuria and strangury.
    • Systemic symptoms
    • Restless patient, often writhing in distress
    • Nausea, vomiting.
    • Fever and chills ( if associated infection)
    • Asymptomatic
    • Incidental stones

  7. Can calculi pass spontaneously?
    • History and physical examination
    • Serum and blood testing Calcium, parathyroid hormone, vitamin D, electrolytes
    • Urine dipstick and microscopic examination
    • Urine culture
    • 24-Hours urine collection
    • Imagining Modalities Plain Radiography, IVP, USG, CT Scans.

  8. What are factors that can effect the management renal calculi?Kidney Yes, Nearly all urethral stones are supposed to be expelled spontaneously when their diameters are smaller than 4 mm. However, the spontaneous expulsion rate of distal ureter stones is about 25% if their sizes are between 4-6 mm and 5% if greater than 6mm. And calculi over 8mm are very rarely eliminated spontaneously. Therefore, active treatments are recommended for individuals with larger stones, especially their sizes are greater than 5 mm.

  9. What are factors that can effect the management renal calculi??Management of a kidney stone depends on its size, location, and composition and the presence of anatomical malformation and complications. The presence of a complication (complicated stone) - infection or obstruction – may necessitate immediate intervention, whereas uncomplicated stones can be managed conservatively with adequate fluid intake and analgesia. If a stone does not pass spontaneously then definitive treatment is needed to remove it. The goals of treatment are to control symptoms, render the patient stone free and prevent recurrence.
Courtasy-Devasya Kindey Hospital.


DISCLAIMER: THE INFORMATION PROVIDED HERE IS TAKEN FROM RELIABLE SOURCES AND IS MEANT FOR GENERAL PUBLIC EDUCATION ONLY.PLEASE DISCUSS WITH YOUR DOCTOR BEFORE IMPLEMENTING THIS.

1 comment:

  1. NICE AND INFORMATIVE FOR ALL DOCTORS
    DR.MUNJAL PANDYA
    www.medicalmcq4all.com

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