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Infection is air borne. water borne Star Health Insurance, the specialist in health insurance, is a trusted and fastest growing insurance company with pan India presence. Committed to good health, it offers a galaxy of products and services in health insurance. Star Health Insurance plans accepted across a network of more than 4900 hospitals in India, opens the door to cashless hospitalization, faster and trouble free 'direct in-house claim settlement'. After all, the glow of a Star not only lights up the galaxy but also your life. With good health… er of solicit amily Health Optima Diabetes Safe Insur ance « Unique Health Insurance « Wedding Gift Insur ance Senior Citizens Red Carpet Insur ance Star Medi Classic Insurance Health Insurance gets « Star Super Surplus Insur ance Star Health Gain Insur ance Overseas Medical Policy Insurance is the subject matt even more better. The Health Insurance Specialist
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About Your Company culosis TB) in India India's First Standalone Health Insurance
Company has begun its operations in May 2006.
Diabetic Foot Infection Today the Company's paid up capital stands at Rs.
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Childhood Infectious Diseases FAMILY HEALTH OPTIMA
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culosis TB) in India resistance. That is why culture with drug sensitivity (to check if the bacteria will respond the drug) in sputum or other samples is advised for all patients. Drug resistant TB needs second line anti TB medicines which are expensive and may have more side-effects. In India, one in every two people has been exposed to TB. Dr. V. RAMASUBRAMANIAN MD FRCP (Glas) DTM&H FGUM
This is why even asymptomatic persons have a positive Consultant Infectious Diseases – Apollo Hospitals
mantoux test. A positive test only tells us that the person has Director – Boosters Adult Vaccination Centre & Travel Clinic
been exposed to TB and hence reacts positively to the test. It DOES NOT diagnose active TB infection. To confirm active infection either a culture that grows the bacteria, or, changes caused by the bacteria should be confirmed on biopsy specimens under the microscope.
Persons with active pulmonary TB are infectious to others (when other organs are involved the person is usually not y the time you finish reading this article two more infectious) and for the first 2 to 3 weeks of treatment need to Indians would have died of Tuberculosis. TB is a killer take precautions. This may include coughing with the mouth disease and is the leading infection causing deaths of closed; avoid staying in a crowd and in unventilated or air- adults in India (1000 a day). India has about 14 million cases, conditioned rooms with others, refrain from spitting in about a third of the World's TB population resulting in an annual loss to the nation of about 12,000 Crores. What is scarier is that multi-drug resistant TB which is becoming TB is a treatable infection but it still kills thousands daily. It is untreatable is on the rise.
the duty of every responsible citizen to get him / her tested to rule out TB and if diagnosed positive take adequate TB is a bacterium that is spread by the airborne route. It can precautions to prevent spread of the infection. It is affect all organs in the body except the hair and nails. About mandatory for a patient to take the medicines as advised by two thirds of cases are lung TB (pulmonary) and one third the doctor to prevent drug resistance to TB.
may occur in lymph nodes, spine, joints, brain or abdomen. The commonest symptoms of TB are low grade fevers especially in the evenings, fatigue, loss of appetite and weight. Depending on the organ involved it may cause a persistent cough with or without blood in the sputum, headaches, a lump over the neck (lymph node), pain over the spine or swelling and pain in a joint lasting several weeks along with fever. The symptoms may be initially ignored as months (four drugs for 2 months and two drugs for 4 non-specific and by the time the patient presents to a doctor, he may be quite unwell. If the medicines are provided by the Government, it may The doctor after evaluation may order a chest x-ray, blood come under the preview of DOTS (Directly Observed tests like the complete blood count, liver function tests and a Therapy Short course) when thrice weekly medicines may sputum test. The ESR (a blood test) is usually elevated. be taken under direct supervision of somebody. This is to Sputum staining may reveal the TB bacterium which needs ensure that the medicines are taken without fail. This is done to be cultured to confirm the diagnosis (the bacteria may to prevent the occurrence of resistance of TB to the anti- TB take 6 to 8 weeks to grow in culture). Once the diagnosis is confirmed, the doctor may prescribe a combination of drugs (Rifampicin, Isoniazid, Ethambutol & Pyrizinamide), along The incidence of TB has increased with the advent of the with a vitamin, all to be taken in the morning. Rifampicin AIDS epidemic the world over. Since persons with HIV/AIDS should be taken on an empty stomach and colors the urine are at increased risk of developing TB, it is recommended orange. There may be some nausea which usually settles in a that all persons diagnosed to have TB should be tested for few days. Severe nausea and vomiting may occur due to side- effects of the medicines on the liver. The TB medicines need Drug resistance in TB (when the medicines do not work) is to be stopped if this occurs. A modification of the regimen on the rise now. This has happened because patients are not may be advised after monitoring the liver functions if this compliant with the medicines. Since the patients start occurs. Another common side-effect of TB medicines is joint feeling normal after a few weeks, many discontinue pains which may occur in a few. The course is usually for six treatment on their own, leading to problems of drug The Health Insurance Specialist
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Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
Diabetic Foot Infection ultimately results in ulceration. Neuropathy is the most risk category: education, special footwear and more important cause of ulceration.
frequent foot examinations by the provider.
Reduction in Blood circulation:
Diabetes mellitus is a disorder that primarily affects the Dr. V. BALAJI - MD – General Medicine
microvascular circulation. In the extremities, microvascular Diabetes Care and Research Institute
disease due to "sugar-coated capillaries" limits the blood supply to the superficial and deep structures. Pressure due to ill-fitting shoes or trauma further compromises the local blood supply at the microvascular level, predisposing the patient to infection. The infection may involve the skin, soft tissues, bone or all of these tissues.
OOT ULCERATION is a disturbing complication of Diabetes also accelerates macrovascular disease, which is Diabetes that often results in a diminished quality of evident clinically as accelerating atherosclerosis and/or life. By a "rule of 15" - 15% of people with Diabetes peripheral vascular disease. Impaired microvascular develop ulcers, 15% of ulcers develop osteomyelitis, and circulation hinders white cell migration into the area of 15% of ulcers result in amputation. Foot ulcers are costly infection and limits the ability of antibiotics to reach the site and they account for about 20% of hospital inpatient days of infection in an effective concentration. Diabetic for people with diabetes. This figure is even more striking neuropathy may be encountered in conjunction with when one considers that 60% of all diabetes costs are for inpatient care. Thus, the economic impact is staggering Administered antibiotics do not penetrate the When the output is amputation, treatment costs further go devascularized infected bone fragments. Therefore, up. For the patient, the profound emotional loss of antibiotic therapy alone cannot cure patients with chronic amputation resembles bereavement. Unfortunately, osteomyelitis without surgical debridement to remove these amputation is not the end of the story. Approximately half of isolated infected elements. Surgical debridement is Diabetic Foot Care:
these patients will have a contra lateral amputation within 3 essential to remove the infected bony fragments that the Our hospital performs routine diabetic foot care which years. Admittedly, many of these people are moribund and at antibiotics cannot reach so that affected areas can be treated high cardiovascular risk, but the psychosocial effects of with antimicrobial therapy.
disease that involves the large vessels, in addition to (1) Nail Trimming: Regular trimming or thinning of nails to
amputation may be very high.
microvascular and capillary disease.
prevent them from becoming thickened and ingrown.
Diabetic foot infections range from cellulitis to chronic In general, people with diabetes have infections that are The most important aspect of diagnosing the foot at risk of (2) Blisters: Treatment of blisters so they do not ultimately
osteomyelitis and globally, they are the most common more severe and take longer to cure than equivalent ulceration is regularly asking the patients to remove their become ulcers and infections skeletal and soft tissue infections in patients with diabetes.
infections in other people.
shoes and socks and examining the foot in detail for evidence (3) Education: Due to the seriousness of diabetes and the
These individuals are predisposed to foot infections because of neuropathy, vascular disease, deformities, plantar callus, What are the risk factors in diabetic patients?
potential severity of its effects, we also educate diabetics on of a compromised vascular supply secondary to diabetes. edema, and other risk factors. A simple foot pressure mat a regular basis about the manifestations of decreased Local trauma and/or pressure (often in association with lack (such as the Pressure Stat system) can help identify high circulation, decreased nerve sensation, weakened bones of sensation because of neuropathy), in addition to Clearly, the most important factor contributing to the pressures under the diabetic foot. Furthermore, these and collapsed joints.
microvascular disease, may result in various diabetic foot development of foot ulcers and faulty healing is peripheral pressure maps of the foot which show higher pressure may (4) Examination: The patient is examined with regard to
neuropathy, especially the loss of protective sensation. be used to educate patients about their risk for subsequent these areas and fully informed of what is occurring with his The spectrum of foot infections in diabetes ranges from Neuropathy causes the recurrent injury sustained in daily or her feet during each visit.
simple superficial cellulitis to chronic osteomyelitis. walking to build into a crescendo of inflammation by the Nerve function can be tested in several ways: Semmes- Infections in patients with diabetes are difficult to treat host. The ulceration's initial lesion is a "hot spot" of Weinstein monofilaments, vibration perception threshold (5) Customized foot wear or gear: Custom shoes, insoles
because these patients have impaired microvascular inflammation over an area of high pressure that is detectable (VPT) or a combination of these modalities can be used to and devices can be constructed for diabetics in order to circulation, which limits the access of phagocytic cells to the with dermal thermography. Moreover, patients with identify patients at risk for foot ulceration. So far, only relieve pressure and pain to abnormal sensitive sites on the infected area and results in a poor concentration of neuropathy also have limited joint mobility and bony intensive glucose control has proved effective in preserving antibiotics in the infected tissues. For this reason, deep skin deformities, which contribute combination of high foot sensory nerve function.
(6) Points of skin irritation: Diabetics can have elective
and soft tissue infections are usually curable, but they can be pressures and an inability to feel them. This results in callus An annual examination suffices for patients in the 0 risk podiatric surgery in many cases, as long as the diabetes is life threatening and result in substantial long-term formation, more pressure and injury, and ultimately, category, because they are at low risk for ulceration. A under control and the circulation status is excellent. patient with mild sensory neuropathy (category 1) should However, any abnormality for the diabetic, such as infection, Chronic osteomyelitis in patients with diabetes mellitus is The neuropathic foot does not spontaneously ulcerate. have a foot examination every six months; patients in the laceration, or manifestations of a foreign object in the foot the most difficult infection to cure. Adequate surgical Insensitivity combined with either extrinsic factors (such as higher risk categories (2 and 3) should visit a specialist at are treated as emergencies, and diabetic patients are debridement, in addition to antimicrobial therapy, is walking barefoot and stepping on a sharp object or simply least every three months and more frequently if they have instructed to contact our offices immediately for treatment necessary to cure chronic osteomyelitis.
wearing ill-fitting shoes) or intrinsic factors (a patient with acute problems.
of these areas of difficulty.
insensitivity an callus walks and develops an ulcer) Individuals with diabetes may also have peripheral vascular Various interventions are appropriate for patients in each The Health Insurance Specialist
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Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
Other Footwear Issues:
(7) Ingrown Toe Nails: An ingrown toe nail is often the result
The very best prescription footwear is not effective if of a genetic problem involving the nail. However, certain patients do not use it. Clinicians must educate their patients closed-in shoes — which the patient cannot properly feel — and provide attractive, socially acceptable shoes that protect can be a contributing factor. This includes extra penetration of against foot injury. Patients must understand that wearing the skin by the nail, swelling, redness and pain.
the prescribed shoes falls into the same category as taking Early detection and prompt attention can not only help
Childhood Infectious Diseases medication-something that is essential for preserving their save feet, they can also be life-saving.
health. The syndrome of the "holiday ulcer" is common How to look after your feet?
place: many ulcers develop at weddings, funerals, religious events or on vacation because the patient selects 1. Keep feet clean – wash them regularly.
Dr. C.B. KRISHNAKUMAR - MD – Internal Medicine
inappropriate footwear "just this once" and usually engages 2. Use only lukewarm water – no hot water, heating pads, hot Medical Advisor – Star Health and Allied Insurance Co Ltd
in increased activity. Compliance with wearing appropriate water bottles, iodine or alcohol.
Corporate Office, Chennai
shoes and avoiding barefoot walking must be stressed at 3. Keep the feet dry – especially between toes-use unscented every office visit. Controversially, the clinician should lotion or cream to keep skin soft.
explain to low-risk patients why they do not need specialized footwear.
4. Use only medicines recommended by your doctor.
Diabetics — Self-Inspection of the Feet:
5. Cut toe nails straight across, not deep into the corners to help avoid ingrown toe nails.
accines prevent and control infectious disease. Many infectious diseases, once common in India, 6. Never use razors, knives or corn caps to remove corns.
V have been controlled and even eradicated by 7. Wear shoes or slippers at all times -never walk bare foot vaccination. Most remarkable ones are small pox, even at home.
which has been eradicated, and polio, which is heading 8. Wear good fitting shoes/slippers - not tight or worn-out ones. Boots should be used only for short periods.
However, the viruses and bacteria which cause disease and 9. Check your feet daily and see your doctor or chiropodist occasionally death that can be prevented by vaccines still immediately about foot problems.
exist and can infect those who are not vaccinated and protected. Children, especially infants and young children How to self examine your feet?
are particularly vulnerable and are affected. They can get 1. Sit on a bed or comfortable flat surface with legs drawn recommended vaccines time and be protected.
close to your body.
Following diseases affect numerous children, but can be 2. Hold a big size mirror beneath your feet 6 – 12 inches away.
easily prevented with vaccination: When diabetics inspect their feet, they should be aware of the following: Look for:
Polio: Infectious disease caused by a virus that lives in the throat and intestinal tract.
(1) Color changes in Feet: Paleness, bluishness and redness
1. Any cracks.
on the legs and toes is often a sign of infection.
2. Peeling of the skin.
Paralysis that can lead to permanent disability and occasionally death.
(2) Swelling: Abnormal swelling may be the result of poor
3. Abnormally dry skin.
Two types – Inactivated Polio Vaccine (Imovax Polio) and circulation or swelling. Other symptoms are extreme 4. Color change in any area.
Polio Vaccine (OPV). Pentaxim too has IPV tenderness and increase in foot size.
5. Any wound that has occurred.
(3) Changes in Temperature: These would include extra-
Diphtheria : Bacterial disease that causes a thick covering in the back of the throat.
warm areas, which may mean that an infection has started. 6. Any shiny appearance on the feet.
Extra coolness may mean a general decrease of circulation Feel your feet with your hands for
Breathing problems, paralysis, heart failure and even death and that the patient is not getting enough blood flow.
1. Abnormally cold feet.
(4) Change of Sensation: This often involves sensations of
Diphtheria toxoid contained in DTwP, DTaP (Tripacel), DT or 2. Any thickening of skin in the soles, especially beneath the "pins and needles," numbness, tingling, burning or lack of Td vaccines & Pentaxim feeling which may be a result of nerve damage or changes in the nerve status of the foot.
3. Any protruding bone beneath the feet.
Pertussis (Whopping Cough): is a highly contagious respiratory tract infection
characterized by typical cough with whoop.
(5) Hot Spots: Various red hot spots are caused by friction or
4. Any change in the shape of the feet.
pressure. These may also turn into blisters, corns or calluses.
5. Swelling of the feet.
Pneumonia, encephalitis (due to lack of oxygen), and (6) Cracks, Sores and Ulcers: These are caused by dry or
occasionally death especially in infants 6. Localized redness or warmth of the feet.
irritated skin, decrease in circulation, or abnormal pressure which is the most common cause of ulceration of the diabetic 7. Ulcers or wounds.
Pertussis vaccine contained in DTwP, DTaP (Tripacel), DT or Inform your doctor if any of the above is present!
Td vaccines & Pentaxim The Health Insurance Specialist
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Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
Measles: A highly infectious disease caused by a Measles virus with characteristic rashes
Influenza (Flu) – A disease caused by influenza virus characterized by abrupt onset of fever,
aching muscles, chills sore throat, and non-productive cough. Additional symptoms may
Diarrhea, ear infections, pneumonia, encephalitis, seizures include runny nose, headache, a burning sensation in the chest, eye pain and sensitivity to light.
Bacterial pneumonia. Viral pneumonia is less common but has high Measles vaccine (contained in MMR MR and measles vaccines) fatality rate. Other complications include inflammation of the heartand worsening of such pulmonary disease as bronchitis Mumps: An acute vial illness caused by the mumps virus
Influenza vaccine (Vaxigrip) Fever, headache, muscle aces, tiredness and loss of appetite, followed by swelling of salivary glands Parents to Note
4 The suggested schedule may be modified by your doctor as per the need.
Mumps vaccine (contained in Mumps and MMR) 4 Immunization can be given in the presence of minor illness (Cold, Cough) Rubella (German Measles) : An acute viral disease that causes fever and rash. Spread
4 Prior to immunization inform your doctor if the child has had any significant reaction/s to the last dose.
by contact with an infected person through coughing and sneezing BCG: A nodule appears 3-4 weeks after BCG vaccination. It may soften or ulcerate in 2-4 weeks. No application or
Birth defects, if acquired by a pregnant woman: deafness, cataracts, fomentation is necessary. It heals, leaving a scar, indicating effective vaccination.
heart defects, mental retardation and liver and spleen damage (at least a 20 % chance of damage to the fetus if a woman is DPT: There may be mild fever, pain, redness and swelling at the site of infections. A small painless lump may remain for few
infected early in pregnancy) weeks. For fever and pain, paracetamol syrup/tablet may be given. The dose can be repeated every 4-6 hours if required. Consult your doctor for any other reaction.
Rubella vaccine (contained in Rubella and MMR vaccine) Measles /MMR: A few children get fever 4 to 10 days after the vaccination. Paracetamol syrup/ tablet may be given if
Tetanus (lockjaw): Serious disease caused by bacteria that causes painful tightening
required. Newer Vaccines: Please seek your doctor's advice regarding these vaccines.
of the muscles usually all over the body Parents are advised to remain in the clinic for 20-30 minutes with their children after vaccination It can lead to "locking" of the jaw so the victim cannot open his mouth or swallow. Tetanus leads to death in about 1 in 10 cases Tetanus toxoid contained in DTwP, DTaP (Tripacel), DT or TT or Td vaccines & Pentaxim Haemophilus Influenza type b (Hib): A severe bacterial infection occurring primarily in infants
Meningitis (an infection of the covering of the brain and spinal cord resulting in death), pneumonia (lung infection), epiglottitis(a severe throat infection) and other serious infections Hib (Acthib), Hib/DTwP (Tetracthib), Hib/ DTaP (Acthib / Tripacel) & pentaxim Hepatitis A : A disease of the liver caused by hepatitis A virus characterized by jaundice
Relapsing Hepatitis A, Fulminant Hepatitis A & Cholestatic Jaundice Hepatitis A Vaccine (Avaxim 80U Pediatric) Varicella (Chickenpox): A disease caused by infection with the varicella zoster virus,
which causes fever and an itchy rash
Bacterial Infection of the skin, swelling of the brain and pneumonia. Adolescents and adults are more at risk for severe disease Varicella Vaccine (Okavax) The Health Insurance Specialist
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Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
mistaken for dengue fever and other hemorrhagic fevers, hepatitis of various etiologies, viral meningitis, malaria and typhoid fever.
Dr. C.B. KRISHNAKUMAR - MD – Internal Medicine
Prevention and treatment
Medical Advisor – Star Health and Allied Insurance Co Ltd
4 Doxycycline (antibiotic) may be used as a Corporate Office, Chennai
prophylaxis for adventure travelers to high risk areas.Treatment is a relatively complicated process comprising two main components: suppressing the c a u s a t i v e a g e n t a n d f i g h t i n g p o s s i b l e 4 Leptospirosis, an infectious disease that affects humans
complications. Aetiotropic drugs are antibiotics, and animals, is considered the most common zoonosis in such as cefotaxime, doxycycline, penicillin, the world. It is a public health problem and in many cases ampicillin and amoxicillin.
leptospirosis can be 'very' deadly. It is however preventable and treatable.
4 Supportive therapy measures (especially in severe 4 Leptospirosis also known as Weil's disease, Weil's
cases) include detoxification and normalization of syndrome, 7-day fever, Rat Catcher's fever is caused
the hydro-electrolytic balance. Glucose and salt by a bacterium called Leptospira and affects humans as solution infusions may be administered.
well as other mammals, birds, amphibians, and reptiles.
Leptospirosis is transmitted by the urine of an infected Corticosteroids administration in gradually animal. Humans become infected through contact with reduced doses during 7–10 days is recommended water, food, soil contaminated with urine from these in cases of severe haemorrhagic effects. Organ infected animals.
specific care and treatment are essential in cases of 4 It is common among water sport enthusiasts who can renal, liver, or heart involvement.
contract the disease by swallowing contaminated water or exposing open wounds to infected water. Occupations Despite the possibility of severe complications, the at risk include veterinarians, slaughterhouse workers, disease is most often self-limited and nonfatal.
farmers, rowers, sewer workers.
4 Leptospirosis is generally associated with tropical countries and heavy rainfall. It is associated in our country with stagnant water.
Leptospiral infection in humans causes a range of renal interstitial tubular necrosis which results in renal failure and often liver failure (the severe form of this disease
is known as Weil's disease.
Symptoms of leptospirosis include high fever, severe headache, chills, muscle aches, vomiting and may include jaundice, red eyes, abdominal pain, diarrhea and rash. Initial The micro organism can be found in blood for the first 7 to 10 presentation may resemble pneumonia. The symptoms in days and then moving to the kidneys. After 7 to 10 days the humans appear after a 4–14 day incubation period micro organism can be found in fresh urine.
Leptospirosis is a biphasic disease that begins with flu-like It is also possible to culture the microorganism from blood, symptoms . The first phase resolves and the patient is briefly serum, fresh urine and possibly fresh kidney biopsy. Kidney asymptomatic until the second phase begins. This is function tests & liver functions are performed. Diagnosis of characterized by meningitis, liver damage (causing leptospirosis is confirmed with tests such as Enzyme-Linked jaundice) and renal failure. The infection is often wrongly Immunosorbent Assay (ELISA) and polymerase chain diagnosed due to the wide range of symptoms. This leads to a reaction (PCR)., Igm(lepto) Serological testing, the MAT lower registered number of cases than exists.
(microscopic agglutination test) is considered the gold standard in diagnosing leptospirosis Complications include meningitis (brain fever) extreme Lepto may resemble which other fevers? leptospirosis due to fatigue, hearing loss, respiratory distress, azotemia and diverse symptomatic manifestations may resemble and be The Health Insurance Specialist
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Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
Malaria: Mosquitoes bite: treatment for decades. This cost effective and safedrug has become useless for treatment offalciparum malaria in many parts of the world dueto development of parasite resistance pharmacological fight!!! Quinine due to its side effects, necessity ofmonitoring and long duration of treatment isreserved for complicated cases In the present scenario WHO recommends the useof ACT (Artemesinin combination therapy) which Dr. ASIYA, MBBS, M.Med.Sc
is highly effective and presents new prospects for Assistant General Manager - Medical
deterring drug resistance Claims Dept., Star Health And Allied Insurance
m e f l o q u i n e , a r t e s u n a t e a m o d i a q u i n e , dihydroartemesin - piperaquin and arthemetin lumefantine.
As the burden of malaria is growing and it is a 4 Malaria is a life threatening disease caused by disease that affects the younger productive parasites transmitted through the bite of infected members of society the need of the hour is effective management and prevention. The 4 Malaria is presentable and curable humble mosquito needs to be kept in check.
4 Non immune travelers from malaria free areas are very vulnerable to disease Scenario in India: About 2 million confirmed cases and 1000 deaths are reported annually, although 15 million cases and 20000 deaths are estimated by WHO South East India Regional office. India contributes 77 % of the total malaria cases in SE Asia.
In India malaria is contributed the most by Orissa states. It contributed 25% of the total 1.5-2 million reported annual cases and 30% of deaths caused by malaria.
Transmission: How does someone get malaria
Malaria is transmitted exclusively through the bite of the female anopheles mosquito. The role of human immunity is vital, the most malaria deaths occur in younger children Diagnosis and Treatment: How do you know you have
Acute febrile illness (chills with sweats) Early diagnosis and treatment of malaria reducesdiseases and prevents death Symptoms usually appear 10-15 days after theinfected mosquito bite It is a major factor needed to reduce malariatransmission among the community Symptoms initially may be mild like headache,chills and vomiting The "gold standard" are thick and thin blood filmswith microscopy If not treated can progress to severe illness thatmay lead to death RDT: Rapid diagnostic tests are based on thedetection of circulating antigens. Several types of Children in endemic areas with severe disease ADT are available develop one or more of the following syndromic presentations: Severe anemia, respiratory distress QBC: Quantitative buffy coat is a microscopic in relation to metabolic acidosis or cerebral based malaria diagnostic tests that speeds and simplifies malaria detection In adults, multi organ involvement is also frequent Chloroquine has been the mainstay of malaria The Health Insurance Specialist
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Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
Enteric fever (Typhoid Fever): Other symptoms are
4 Considerable weight loss Uncomplicated cases do not require hospitalization.
4 Extremely distended [ bloated] abdomen Most of the patients can be treated as an outpatient
The Chameleon among basis at home with oral antibiotics and antipyretics.
A complete blood count (CBC) shows increased WBCs.
Hence there is no need to panic if one is diagnosed with
Typhoid Fever. It can be cured completely with oral

infectious diseases There may be also leucopenia- decreased white cell count.
antibiotics, antipyretics and rest at home.
1. A blood culture during the first week of the fever can
Hospitalization is indicated only when Patients are
show S. typhi bacteria. This is the most specific test.
Toxic, Dehydrated having Low blood pressure, Unable to
2. Widal test: The test is based on demonstrating the
take orally, having severe vomiting or diarrhea or when
Dr. S. KRISHNASHANKAR, M.B.B.S, DNB [General Medicine]
presence of agglutinin (antibody) in the serum of an infected there is Progressive abdominal distention with Pain.
Senior Medical Consultant
patient, against the H (flagellar) and O (somatic) antigens of Star Health And Allied Insurance Co Ltd
Salmonella typhi. Fluids and electrolytes are given through a vein Claims Office, Chennai
H POSITIVE in 1 in 160 dilutions and 0 positive in 1:80
(intravenously) to correct dehydration dilutions is significant.
Appropriate I.V. antibiotics Those individuals, who had suffered from enteric fever in the past, sometimes develop anti-Salmonella antibodies during Fluoroquinolones [E.g.Ciprofloxacin, Ofloxacin] and 4 About 22 million cases of typhoid fever and 2,00,000 After the ingestion of contaminated food or water, the an unrelated or closely related infection. Third generation Cephalosporins [E.g. Ceftriaxone, deaths occur yearly worldwide making it a very deadly Salmonella bacteria invade the small intestine and enter the cefixime] have been recommended for the treatment of infectious disease causing high disease burden bloodstream temporarily. The bacteria are carried by white This is termed Anamnestic response and can be
especially in the developing world.
blood cells in the liver, spleen, and bone marrow. The differentiated from true infection by lack of any rise in titre Macrolides [E.g. Azithromycin, Clarithromycin] are also bacteria then multiply in the cells of these organs and on repetition after a week.
4 Enteric fever also known as Typhoid fever is an Acute
reenter the bloodstream, during which the Patients develop
illness with Fever caused by infection with the Neither sensitive nor specific, the Widal test is no longer
symptoms, including fever.
The duration of treatment is for at least 10 days or for 5
Salmonella typhi bacteria
an acceptable clinical method.
days after fever resolution.
The Bacteria then invade the gallbladder, biliary system, and 4 Contracted from contaminated water and food. 3. ELISA urine test to look for the bacteria that cause
the lymphatic tissue of the bowel. Here, they multiply in high 4 It can also be caused by Salmonella Paratyphi, a
numbers. The bacteria then pass into the intestinal tract and If treated with well-selected antibiotics, patients respond related bacterium that usually leads to a less severe 4. Stool culture- Stool culture alone yields a sensitivity of
can be identified for diagnosis in cultures from the stool well and fever should subside within less than 50%, and urine culture alone is even less sensitive.
tested in the laboratory. 4-5 days.
4 Disease is transmitted through contaminated drinking 5.USG abdomen is useful if bowel perforation
water or food. Incidence of typhoid fever in Indian (symptomatic or asymptomatic) is suspected and to detect The outcome is likely to be good with early treatment, but The disease has an insidious onset characterized by population is 0.5% - 1%.
liver and spleen enlargement [Hepatosplenomegaly] becomes poor if complications develop.
4 Prolonged High grade fever >101.4 f The term "Enteric fever" is a collective term that refers
to Typhoid and Paratyphoid.
4 Myalgia (muscle pain). Mode of transmission
Typhoid fever is contracted by the ingestion of bacteria in contaminated food or water. 4 Nausea and vomiting 4 Malaise- Generalized feeling of discomfort, illness, or lack of well-being 4 Arthalgia- Pain in the joints 4 Delirium – Acute Confusional state 4 Intestinal perforation 4 Death may occur in severe cases The incubation period is usually one to two weeks, and
the duration of the illness is about four to six weeks.

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Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
4 Intestinal haemorrhage (Severe GI bleeding) Two vaccines are currently in use:- Prolong your hospital stay 4 Intestinal perforation Vi capsular polysaccharide vaccine (or ViCPS) is
injected in a single dose [The vaccine is injected either
under the skin or into a muscle at least seven days before travelling to the typhoid-affected area] The other vaccine Typhoral - Ty21a is given orally over
Other less common complications include:
a period of days. An initial course of 4 doses on alternate "prolonged stay"! days is recommended. Full protection is achieved 7 days 4 Inflammation of the heart muscle (Myocarditis) after the last dose.
4 Inflammation of the pancreas (Pancreatitis) 4Wash your hands often Senior Manager – Medical
4 Psychiatric problems such as delirium, hallucinations 4Clean household items daily Star Health and Allied Insurance Co Ltd
and paranoid psychosis 4Choose hot foods Claims Office, Chennai
4 Typhoid Abscess, osteomyelitis [infection of bone] and 4Keep personal items separate Orchitis [inflammation of one or both of the testicles]
4Have a Good personal Hygiene Sanitation and hygiene are the critical measures that can be Sickness creates anxiety and when you are hospitalized for taken to prevent typhoid. Typhoid does not affect animals 4Avoid drinking untreated water an illness, it is only natural that you want to stay as long as and therefore transmission is only from human to human. Urinary infection 4Avoid Raw fruits & vegetables you feel completely normal. However, do you know that you Careful food preparation and washing of hands are crucial to 4Avoid Partially cooked food are at risk of developing newer infections in the hospital? preventing typhoid. Carriers of typhoid must not be allowed Surgical site infection to work as food handlers.
4Avoid food from street vendors 4Avoid handling food if you are infected You can acquire infections during hospitalization. Any new infection that you get in a hospital, where you are admitted Infection through for some other illness is called "hospital-acquired infection" and it can affect any part of your body as outlined below.
Skin and soft tissue 4 Urinary tract infection – is the most common type of hospital acquired infection and it is associated with the use of urinary catheter 4 Infection of the operated site – can result from the spread of infection from one person to another. Thus, you contamination during surgery can get the infection from another patient, visitor or the 4 Pneumonia (lung infection)– more common in patients, hospital staff through direct contact, or contaminated air, who are on ventilators in intensive care units water, food, medicaments or objects. Alternatively you can get the infection from your own body parts that are normally 4 Infections through the blood stream – usually spread home to micro-organisms (nose, urinary tract etc). The through the vascular catheters germs that commonly cause hospital-acquired infections 4 Skin and soft tissue infection – such as ulcers and are bacteria, virus and fungi, such as coagulase-negative staphylococci, Enterococcus, Staphylococcus aureus, Candida albicans, Psudomonas aeruginosa and 4 Gastro-intestinal infection (diarrhea/vomiting) Haemophilus influenza. Some of the infecting germs are 4 Sinusitis (sinus infection) naturally found in our environment without making us sick. 4 Meningitis (brain fever) However, when we are ill and hospitalized our resistance is low, thus making us susceptible to infections. Who gets the infection?
4 Endometritis (infection of the uterus) following child Any patient admitted in a hospital can get infected. However, very young and very old people, those who have poor How does the infection spread?
immunity, undernourished individuals and those who have Though hospital is the place to get treated for an illness, too long-standing health problems such as diabetes and cancer, many sick people gathering under the same roof facilitates are more susceptible to infection during hospitalization. The Health Insurance Specialist
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Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
"Longer the hospital stay, greater is the risk". such facilities.
What happens to infected patient?
4 Hospital-acquired infection can extend your hospital Prevention of skin Generally, infected patients have fever, weakness, skin rash, stay and add to the emotional stress of hospitalization. low blood pressure and increased blood counts. In addition, Moreover, it is surely not going to be light on your wallet! patients may have symptoms related to the type of infection; When you wish to prolong your hospital stay, remember that Infection for the for example pneumonia may cause cough and you may indeed end up having a "prolonged stay". Hence, it is breathlessness. Unnecessary and wide spread use of only prudent to limit your hospital stay to the extent it is antibiotics has made normally harmless germs into super absolutely necessary. bugs (Ex: Methicillin-resistant Staphylococcus aureus or "Fewer days in the hospital, the better"!
MRSA), which are resistant to multiple antibiotics making treatment of these infections difficult. Nonetheless, these infections are usually treated with two or more expensive Dr. ANAND., MD.,DD.,DNB
antibiotics in addition to the symptomatic treatment. Most patients recover, though at times the infection may lead to death.
Prevention of hospital acquired infection:
Hospital-acquired infections can be prevented by observing proper personal hygiene by the hospital staff and visitors, complete sterilization of medical equipments, safe professional practices, providing a clean, sterile The skin is the largest organ in the body as it has a surface environment in the hospital and appropriate use of area of about 1.6 sq m in an average adult. It helps you protect from heat, light and injury. Obviously with such a large surface area there is enough scope for the skin to get infected by germs.
Hand hygiene saves lives!
Common skin infections like simple boils (folliculitis/ furuncles), infections involving the skin and soft tissue infection (Cellulitis) are caused by bacteria. Apart from these there are viruses (warts) and fungi (jock itch/dhobis itch) also causing human skin infection. Where do these bacteria come from – well mostly from your skin itself because the commonest bacteria causing infection are the Streptococcus and the Staphylococcus (types of bacteria) are always present on the skin. Apart from these them with soap and water and allowing them to dry there are several types of bacteria which can be acquired from our surroundings. One of these is by direct contact 4 Wash your hands after using the bathroom, changing a such as a handshake or a hug (Friends / children or pets) the child's diapers. other method is known as fomite transmission via inanimate objects like handkerchiefs, towels or toilet faucet handles 4 Test your pets for parasites regularly and dispose of etc. When there is a break in the skin surface it allows germs their feces in a sanitary manner. (Bacteria) to enter the skin and cause an infection. Infected 4 If someone is sick at home avoid touching any sores, Points to ponder:
skin is red swollen, warm and often tender (pain on touch). feces, or body fluids without gloves and afterwards. 4 Observing simple hygienic practices (ex: hand washing) Pus is formed when the body's immune system tries to B) At work and in Public places
during hospitalization helps to prevent infection! destroy the bacteria. As the pus collects it can push the 4 Antibiotics should be taken only on the advice of a healthy skin aside and can spread inside resulting in fever 4 Avoid shaking hands (as long as it is within limits of doctor. Avoid buying over-the-counter antibiotics for and malaise.
minor infections like common cold. How do we avoid infection of skin? Well prevention is better 4 Avoid handling money, touching door handles, elevator 4 Proper sterilization of the operation theater and than cure. Listed below are common situations where we buttons, light switches, handrails in public places.
equipments is critical to prevent post operative can all start practicing good skin hygiene.
4 Dry clean your Neck ties regularly – if possible don't infections. Centers that perform large number of A) At home
wear it as it is a source of infection.
surgeries in a day, such as laparoscopy or cataract 4 Wash your hands before cooking or eating. 4 Clean your keyboard and mouse periodically (if possible surgery, may not be able to maintain required standards daily) with a tissue and glass cleaning solution of sterilization. Therefore, it is sensible to avoid using 4 Keep cutting boards and Kitchen table clean by washing The Health Insurance Specialist
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Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
4 Do not rub your eyes, pick your nose, and put your fingers in mouth especially after touching any contaminated surfaces till you wash your hands. 4 Avoid walking barefoot. To prevent wart infections and athlete's foot, avoid walking barefoot in public areas and avoid sharing shoes and socks.
Be Safe Under the Sun C) In the Gym (especially as lot of us have started being
health conscious)
4 Carry your own towels and if possible exercise mats. It would help to carry a hand sanitizer. 4 Do not train if you have an infection as you can contaminate the gym equipments 4 Remember to shower immediately and properly. A sweat soaked shirt is very easy to cause an infection Washing tips
We all know that summer and sickness always goes hand in 4 Allow soap to remain on skin for at least 10-15 seconds.
hand as if they are the best pals. Erratic mercury levels see us 4 Use a mild soap or a neutral pH soap most of the so called all developing infections like cold, viral fever etc. All we need disinfectant soaps or anti-bacterial soaps are pretty to do is strengthen our immune systems, by proper fluid and harsh and may damage your hands if used too regularly.
flood intake. As our body is almost two thirds water and water is critical to nearly every part of the body. It helps to regulate 4 If you are used to a loofah (mesh sponge) do not rub too vigorously. Vigorous scrubbing causes small abrasions body temperature carries nutrients and oxygen in the blood on the skin allowing bacteria to enter the skin and 4 Do not share towels and wash towels after each use.
stream, moistens oxygen for breathing, protects and cushions possibly cause infection.
4 Dry by patting don't scrub with your towel vital organ. But if our body succumbs to the infection the only remedy is to take medication and rest.
4 Wash the nape of the neck and hairline thoroughly.
4 Use a moisturizing cream after washing.
There are two very important things which have to be noted during summer.
Firstly - - - If sick what has to be done while exercising?
Well a few signs can help us to decide whether we are fit to exercises or not, like how bad is the pain? Where is it? Suppose if your temperature before workout is 99.5 degree or above, avoid exercising. Fever is one of the protective mechanisms of our body which indicate that the body is under stress. Working out elevates the body temperature, putting more stress on your immune systems, thus preventing early recovery. Rise in temperature decreases body fluid by 5 – 10 percent causing dehydration resulting in muscle cramps and spasms due to reduced level of body salt. Drinking water helps to restore the lost body salts.
It is safe to workout with symptoms like watery eyes, or irritating throat which does not aggravate with minimal activity. But exercises are not recommended when you have a body ache, chills, chest congestions or diarrhoea. It's always better to wait until symptoms are gone.
recovery. Also watch for other signs like excess or decreased Once you are in the path of recovery from illness gradually perspiration, shortness of breath, low energy level, nausea resume your workout with low intensity for at least 1 week. Stop your workout if you feel your heart rate is higher than Secondly - -What should be done to prevent infection
normal. Take this as an indication of your incomplete during summer while exercising? The Health Insurance Specialist
The Health Insurance Specialist
Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
Drink before, during and after the exercise.
Make water a steady part of your everyday diet.
Eat more fruits and vegetables as they are very high in water content which will keep you hydrated.
Check your hydration level by watching your urine. Urine should be light to clear unless you are talking supplements, which will darken the colour for hours after consumption Drink even before signs of thirst appears. Thirst is a (Make 8 medium size idlis) signal that your body is already on the way to dehydration.
Calories: 104 each Drink one to two glasses of water at least one hour 4 Grate carrots and chop all other vegetables finely.
before the start of exercise.
Drink four to eight ounce of fluid every 15 to 20 4 Heat oil in a frying pan.
minutes during exercise.
If your are exercising more than 60 minutes, start Red, green and yellow capsicum 4 Once hot, add the mustard seeds, when they begin drinking a sports drink, which will replace sputtering add curry leaves and asafoetida.
carbohydrates and electrolytes Drink 8 ounces of fluid within 30 minutes after Add the onions. When they become transparent, 1 small (or a few put in your chopped veggies and stir over a high Hydration is always important to your health, but it flames. Cook only for a couple of minutes, till the becomes even more crucial when you're working raw smell disappears.
up a sweat. So keep the water handy and drink it liberally. Enjoy your summer vacation!
4 Remove from flame, cool for a few minutes and add to Idli batter.
Pour into Idli molds and cool as you would yournormal Idlis.
4 Serve hot with onion tomato chutney.
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Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
24x7 Expert Medical At Star Health Insurance, we always interact with customers with a humane and healing touch. We ensure it remains the same when customers need assistance by keeping the claim process simple and easy. We have a 24x7 medical assistance for consultation and facilitation with regard to hospitalization needs. Our aim is to It has been our motto to ensure preventive care information and provide cashless hospitalization in a hassle - free and time bound manner.
assistance for good health and as a back stop provide financial indemnity though insurance cover. To address the magazine and the We have entered into arrangements with network hospitals to provide cashless new initiative is 24x7 free expert medical consultation over phone.
hospitalization, so you don't have to worry about any advance payments. The steps to avail this benefits are as follows: When do you utilize this service
Inform the Star Health Call Centre by quoting the Star Identity Card or Policy Whenever you feel like visiting a doctor, say, for a common ailment viz, number within 2 hours of admission. This is mandatory.
cold, cough or body pain, before proceeding, what you have to do is to call our Toll Show the Star Identity Card / quote the Policy number at the hospital reception free number. The Medical and request for cashless hospitalization.
personnel will take the details Ensure that the completed Pre - authorization form and related medical reports from you and you will be are faxed to the Star Health Call Centre by the hospital. This is mandatory.
advised simple preventive steps, A copy of Pre-quthorization form duly filled along with all relevant medical over the counter medicines or reports (that substantiates the need for hospitalization) should be provided by the suggest you to go for a medicines or suggest you to go for a medical hospital to the visiting Star Health doctor.
consultation. Our Toll free number is 1800 425 2255 and it is mentioned in the policy document.
On receipt of duly filled Pre-authorization form and based on the feedback from Star Health's doctor, appropriate decision will be communicated to the hospital by Language: The receiver of the call will converse in Tamil, Hindi,
Malayalam and of course in English. We will be thankful to receive in English. We will be thankful to receive your communication on any The authorization letter mentioning the amount sanctioned for the treatment will suggestions to make the system better and more effective to the be faxed to the hospital. This helps the policy holder to get treatment without editor of this magazine.
paying any money to the hospital.
SMS "STAR" to 56677
Toll Free: 1800 425 2255 Fax Toll Free: 1800 425 5522
Disclaimer: No part of this publication may be produced without the prior permission of the publisher.
All care has been taken about factual accuracy in compilation, updation and validation of information.
However, the publisher accepts no responsibility for inadvertant errors, if any, and their consequences.
Insurance is the subject matter of solicitation.
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Consult our Expert Doctor for Free Medical Advice on our Toll Free Number 1800 425 2255.
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Rechercheergebnisse zur Leitlinie Behandlung von depressiven Störungen bei Kindern und Jugendlichen (Stand: 12.12.2012): Pharmakotherapie Evidenztabelle Pharmakotherapie zur Leitlinie „Behandlung von depressiven Störungen bei Kindern und Jugendlichen" © Autoren. Diese Tabelle kann vorläufig wie folgt zitiert werden: Dolle, K. & Schulte-Körne, G. (2012). Evidenztabelle Pharmakotherapie zur Leitlinie „Behandlung von depressiven Störungen bei Kindern und Jugendlichen". Unveröffentlichtes Dokument. Nach Veröffentlichung auf der Homepage der AWMF kann diese Tabelle wie folgt zitiert werden:

Synergistic effects of noradrenergic modulation with atomoxetine and 10�hz repetitive transcranial magnetic stimulation on motor learning in healthy humans

Sczesny-Kaiser et al. BMC Neuroscience 2014, 15:46 Synergistic effects of noradrenergic modulationwith atomoxetine and 10 Hz repetitivetranscranial magnetic stimulation on motorlearning in healthy humans Matthias Sczesny-Kaiser1*†, Alica Bauknecht1†, Oliver Höffken1, Martin Tegenthoff1, Hubert R Dinse2, Dirk Jancke2,Klaus Funke3 and Peter Schwenkreis1