Beriberi:-

Beriberi is the vitamin B1 deficiency disorder specially thiamine deficiency, resulting in neurological disorders. Nervous system, cardiovascular system, and muscular systems are affected by beriberi or Vitamin b1 deficiency. Meaning of beriberi is  “I can’t, I can’t “. Beriberi is common in Southeast Asia where people uses rice with poor thiamine as staple food.

Types of Beriberi:-

Two main types of Beriberi are,

Wet Beriberi : Cardiovascular system is affected with wet beriberi and

Dry Beriberi : Nervous system is affected with dry beriberi.

Causes of beriberi :-

Vitamin B1 – thiamine deficiency is the main cause of Beriberi.

Beriberi is common in patients with  alcohol abuse, because excess alcohol consumption leads to poor  nutrition, and absorption of vitamins and minerals  is very less.

People who consumes diet with less with thiamine, i.e. Polished white rice will get beriberi.

Beriberi is common in people who eat white polished rice ( less in thiamine) as staple food.

Beriberi may also seen in patients after Gastric surgeries.

Genetic beriberi is rarely caused and is due to family history or genetic inheritance. Patients with genetic beriberi, intestines fails to absorb thiamine or vitamin B from foods ingested. The symptoms of Genetic beriberi are usually seen during adult age.

Babies who receive less thiamine containing milk from mother can also affected by Beriberi. Formula feeding infants with inadequate thiamine also can suffer from Beriberi.

Dialysis to treat other diseases, and Diuretics can increase the risk of Beriberi.

Symptoms of Beriberi:-

• Weight loss,
• Loss of appetite,
• Emotional disturbances
• General weakness,
• vomiting,

Dry beriberi Symptoms:-

• Nerve damage,
• Impaired sensory perception,
• Partial paralysis,
• Peripheral neural damage,
• Loss of sensation in feet and legs,
• Mental confusion,
• loss of muscle co-ordination,
• Pain in the limbs,
• Tingling,
• Difficulty in walking,
• Increased amount of lactic acid and pyruvic acid in blood,

Wet beriberi Symptoms:-

Cardiovascular abnormalities,

Cardiac failure,

Congestive cardiac failure, are main symptoms of wet beriberi.

Weakening of capillary walls,

Increased heart rate,

Shortness of breath,

Awakening at night with sweating,

Cardiac symptoms becomes fatal, if not treated,

If not treated beriberi may lead to death.

Treatment of Beriberi:-

Thiamine Hydrochloride in tablet form or in injection form is given to treat Beriberi. Even with an hour of treatment with thiamine hydrochloride itself the patient recovers from Beriberi symptoms.

• High doses of thiamine injection,
• Unrefined cereals,
• Fresh foods such as  meat, legumes,
• Green vegetables, fruits , and milk are provided to treat beriberi with rich thiamine supplement.

Low white blood cell count:-

The decrease in the number of white blood cells than normal level is called as low white blood cell count. Leukopenia is the medical term used for low white blood cell count. White blood cells as the components of blood circulates throughout the body and fights against infection, while provides immunity to the body. Children are the more sufferers from this disorder than elder ones.

The white blood cells plays a major role in providing resistance to body. The main component of immune system of human body is white blood cells. When the white blood cells the resistance power of body is reduced and the individual can’t fight against infection. The individual is prone to have recurrent infections which stays for long time. AIDS patients have low white blood cell count and reduced lymphocytes and that is why they will have severe infections.

The inflammatory symptoms such as redness, swelling, pus formation, cough, fever etc develops very poor or may these inflammatory reactions are absent in patients with low white blood cell count as there is no enough white blood cell count to fight against foreign bodies. So seek medical medical help for even small discomfort or infection.

Neutropenia is the term used to indicate decreased number of neutrophils, the component of white blood cell, which leads to low white blood cell count.

The normal range of white blood cell count  in body is 7000 to 11000 cells per cubic mm of blood. The low white blood cell count  less than 5000 cells per Cm can be said as low white blood cell count. The low white blood cell count may vary from medical institutions to institutions. A low white blood cell count in children is not similar to elders and different according to age group. Leukopenia is  also called as low white blood count.

The white blood cells have different component cells which also determines the low white blood cell count. Decrease in any one of component cell also leads to low white blood cell count. The laboratory test determines the number of cells in the given blood sample.

Normal white blood count in adults:-

* Total white blood count – 4000 to 11ooo / UL
* Lymphocytes  – 22 to 44 %
* Monocytes  – 0 to 8 %
* Neutrophils  – 40 to 70 %
* Eosinophils  – 0 to 4 %
* Basophils  – 0 to 1 %

Causes of low white blood cell count:-

* Altered bone marrow function  because of Viral infections,
* Congenital disorders which diminishes bone marrow function
* Metastatic cancer and other illness that damages bone marrow
* Autoimmune disorders which destroys bone marrow cells
* suppressed immunity due to recurrent infections
* Some medications also causes low white blood cell count by inhibiting  white blood cells or damaging bone marrow

Specific causes of low white blood cell count:-

* Severe allergic reactions
* Aplastic anemia
* Chemotherapy for treatment of cancer,
* Steroids such as prednisone,
* Use of medications such as  antibiotics, diuretics
* Immune deficiency disorder
* HIV infection
* Destruction of blood cells by spleen
* Hyperthyroidism
* Infectious diseases
* Myelofibrosis
* Kostmann syndrome, a congenital disorder with low neutrophil production
* Myelokathexis, a congenital in which  neutrophils fails to enter blood stream form production site.
* Autoimmune disorders
* Parasitic diseases
* Radiation therapy
* Vitamin deficiency disorders

Facts about low white blood cell count:-

The low white blood cell count is  found when the laboratory test is suggested by your doctor and test results gives the exact level of low white blood count level in blood or individuals body. The laboratory results gives clear picture about the percentage of low white blood count and this helps the physician to treat the condition and to take any measures needed. Low white blood count is the clear indicator of decreased immune level in the body and the individual is prone to have recurrent infections. Further diagnostic tests such as x – ray, ultrasound scan, bone marrow aspiration, biopsy  are done to assess the condition of spleen and bone marrow. The low white blood count commonly occurs as a side effect of chemotherapy given to cancer patients.

Precautions to prevent infection:-

The patients with low white blood count should follow the precautionary measures to prevent infection by wearing face masks, avoiding contact with infected person, beware of contagious or communicable diseases, etc. Use face mask to avoid transmission of infection through nose and upper respiratory tract.  practice hygienic measures to prevent infection and protect health.

When to contact  a doctor  about low white blood count ?

* An elevated  temperature greater than 100.4°F.  you can check temperature with  the help of thermometer.
* Sudden and recurrent Chills (rigors) or body shakes,
* Sudden onset of  pain with unknown cause,

When you experience all these symptoms with known low white blood count, contact doctor immediately.

If you experience symptoms such as

* Sore throat
* mouth Sores
* A white patches in  mouth,
* tongue lesions
* Signs of a urinary bladder infection  such as
* painful urination or burning sensation,
* red blood cells in urine
* frequent urination than normal

along with decreased or low white blood count, is better to seek medical help as soon as possible to prevent any complications.

Treatment of low white blood count:-

Low white blood count is treated by relieving from the actual causes. The careful diagnosis helps in assessment of disease condition and treatment is given as per requirement. The medial research  indicates that some foods and food components helps controlling low white blood cell count.

The doctor will prescribe the medications such as

* Filgrastim
* Pegfilgrastim
* Sargramostim

after each cycle of chemotherapy in order to prevent low white blood cell count  for prolonged time. The prophylactic  antimicrobial medications such as Sulfamethoxazole – trimethoprim,   Fluconazole,  Itraconazole   are prescribed to prevent specific infections which occurs with weaken immune system or low white blood count (associated with chemotherapy).

Some  specific foods such as  garlic, foods high in zinc such as oysters, pot roast, dark meat turkey and pumpkin and squash seeds are helpful in boosting immune system of the body and these foods intake reduces the risks of low white blood count. Fruits and vegetables are good for health and stimulates production of antibodies and gives resistance to body. Multivitamin intake is very beneficial with this disorder.

Childhood obesity:

Obesity is considered as most widely spread physical disorder of the human body and has become a vast problem as a obese children. In the modern era, decrease in the physical activity, change in the dietary patter, especially most of the people adopting junk food like bread, chips etc, can increase the risk of obesity and obese children.

Definition:- If an excessive fat accumulates in the body it is known as Obesity. A person is considered to be obese children, if the body weight is more than 25 percent in boys and more than 32 percent in girls.

Obese children:- childhood obesity or obese children is defined as, if 120 percent more weight compare its height ratio is known as childhood obesity.

Obese children are usually measured by using skin fold measurement, mainly the amount of fat present in the sub scapular region, calf and triceps reason. In this triceps and calf or triceps and sub scapular, or calf alone have been used with children and adolescent to find out obese children. If the skin fold in boys is more than 10-25 and 16-30 in girls is present it is considered as normal.

The problem associated with  childhood obesity are:-

Obese children has more risk of getting Type 2 Diabetes mellitus, which is increasingly diagnosed in children now days. Type 2 diabetes is previously considered that it is found only in adolescence. Type 2 diabetes is caused due to increased risk of pediatric hypertension.

* Bulimia: It is an eating disorder, may associated with obese children.
* Respiratory problems such as restriction in the chest wall, causes breathlessness; airway obstruction, etc were found in obese person or in obese children.
* Liver may damage in obese children.
* Sleep apnea: a condition in which there occur a difficulty in breathing during sleeping,
* Cardiac disorders such as Cardiomyopathy may occur in obese children. Cardiomyopathy is a problem associated with heart muscles, in which there is a need of an extra effort to pump the blood from the heart; obesity increases the risk of coronary heart disease,atherosclerosis, and diabetes.
* Other body system disorders involve gallstones, arthritis and hernia.
* Orthopedic problems also associated obese children.
* Obesity increases stress on weight-bearing joints.
* Obese children will have low self-esteem, which affects the Child relationship with his/her peer group.
* Obese children may get psychological problems and affects social relationship as well.
* Low life expectation is also seen in obese children. etc

Causes of children obesity:-

If the amount of intake is more than the amount of energy expenditure, the body will store excessive energy as fat. If this process continues more and more fat will get accumulate in our body and that causes obesity. The following are the causes which lead  obesity in obese children.

Genetics/Hereditary : If the parents are having obesity in their family that is the main cause of the obesity in infants and obese children. And some of the genetic disorders that too were the cause of the obese children.

Food : food is the primary factor to cause obesity. Whatever food we select those decide our physical development and our mental development as well. Foods that rich in high fat and sugar rich foods cause obesity.

Sedentary life style : It decreases physical activity of a child, increases the accumulation of fat and other things in the body. The children who spend more time in watching the television, playing video games, spending more time inside the room with less energy expenditure are more prone to develop obesity.
Alcohol intake increases the risk of obesity. Alcohol increases the calories in liquid form in addition to a full diet.

Assessment of obese children:-

Obese children can be assessed by the estimation of total body weight, measuring skin-fold, and by measuring body weight. If body weight is higher than normal by 20 percent may be considered as obese.

Prevention of obesity:-

It is the more important responsibility of all the parents to prevent the obesity in its early stage. According to one proverb “Prevention is than to cure”, so it is better to prevent the development of obesity than its cure. The following are the remedies that help you to prevent and cure the obesity in children.

Nutritional therapy for obese children : Principles of nutritional therapy are as follows.

* Eat regularly.
* Do not skip meals.
* Eating regular meals which are low in calories,
* Avoiding high calorie foods frequently.
* Measure foods to determine the correct portion size.
* Avoid concentrated sweets, such as sugar, candy, honey, pies, cakes, cookies, and regular sodas in obese children.
* Increase the intake of more green leafy vegetables, fruits and adapting to the vegetarian diet will reduce  obesity risk in obese children and keeps the person or child in healthy condition.

Exercise : is an essential part of a weight-control program. Exercise increases energy loss, hence it increases appetite, but in a later stage it has an opposite action. Exercise increases body fat distribution, hence it reduce the waist-hip ratio as exercise is continues. Maintain a regular exercise program for successful weight loss  in obese children.

Behavior Modification: It involves self-monitoring, stimulus control, and rewards.

Drug Therapy: Drugs have been used in the treatment of the obesity but only as adjuncts to a good diet and exercise program. There are two categories of drugs used to treat obesity. They are as follows,

Appetite-suppressing drugs. Eg- Adipex-P, Fasting.
Nutrient absorption-blocking drugs. Eg- Xanical.

Surgery is  performed to reduce childhood obesity.

* Lipectomy : It is performed to remove unsightly flabby folds of adipose tissue in obese children.
* Liposuction: Here excessive fatty tissue is removed by using the method of suction. The areas involved in this procedure are chin, abdomen, waist and upper thighs of obese children.

* Gastrointestinal Surgeries: like a Vertical banded gastroplasty- It consist of construction a small pouch with a restricted outlet along the lesser curvature of the stomach in obese children. This reduces the gastric capacity and hence will reduce the obesity in obese children. It’s advantages involves, this procedure is easy to perform , more normal anatomy and physiology can maintained in children.
* Roux-en-Y: Gastric bypass procedure involves constructing a proximal gastric pouch whose outlet is a Y-shaped limb of small bowel. This reduces gastric capacity, some malabsorption. It has advantage as it helps in large weight loss in obese children.

Amnesia / Short term memory loss:-

Amnesia is the psychological term used to describe Memory loss.  Amnesia is associated with temporary memory loss or  permanent memory loss. Amnesia affected patients forget what happened in their past life.  Amnesia may come  sudden or slowly, is depends on the etiological factors.

Anterograde amnesia :  The person is incapable of learning new things  and can’t remember the events happened after the attack of Amnesia.

Retrograde Amnesia : Person forgets the past events in their life and fails to recall memories.

Causes of Amnesia:

Number of factors are responsible for Amnesia.  Brain damage is the main cause of Amnesia.  Damage caused to memory centers of brain leads to memory loss. Psychological  factors also causes Amnesia is termed as Psychogenic Amnesia.  Degeneration of brain cells in diseases such as Dementia, malnutrition, Drug abuse and other factors leads to brain cell death causes Amnesia.

• Head injury,
• Using some drugs,
• Encephalitis or brain infection,
• ECT or Electroconvulsive therapy
• Hysteria or Emotional shock,
• Cerebral Stroke,
• General anaesthetics
• High degree fever,
• Seizures and convulsions,
• Consuming alcohol,
• Traumatic events,
• Brain surgery
• Alzheimer’s disease,

Symptoms of Amnesia:-

Memory loss is the main symptom of Amnesia. Memory loss depends on the severity of causes. Memory loss may be temporary or permanent.  The amnesia affected person may not able to recall what happened in their past or not able to learn the new things from the environment.  The victim may forget ones personal identity such as name, age, residing place etc..

Fails to identify familiar persons or places.  Even the person can’t remember where he is Staying, when does he got an injury,

Confusion in doing daily living activities as the memory power has been reduced because of Amnesia.  After partial recovery the confusion is common.  In this stage the memory is not completely lost but the short term memory is weak and it leads to confusion.

After recovering from Amnesia, affected person can’t remember the events from past Amnesia episode.

Bloody mucus stool:-

Individuals with lower intestinal and rectal complaints usually passes hard stool looks covered with mucus. Bloody mucus stool may be associated with pain or without pain. Hemorrhoids or  Anal fissures are the common cause of hard stool with blood and mucus.

Painful defecation and passing bright blood may be because of presence of hemorrhoids. Irritable bowel syndrome is one of the main cause of bloody hard mucus stool. Colitis, an inflammation of the lining of the colon leads to stool with mucus and bleeding. Diarrhea or passing loose stools are the main symptoms of Colitis.

Causes of bloody mucus stool:-

Polyp present in lower rectum  also leads to  passing stool associated with intermittently bleeding.  Causes of bloody mucus stool are:

* Bloody diarrhea,
* Bloody mucus in stool,
* internal bleeding

Some possible causes of bloody diarrhea are  include:-

* Gastroenteritis
* Regional enteritis,
* Colitis,
* Rectal bleeding,
* Acute digestive infection
* Acute food poisoning
* Shigella food poisoning,
* salmonella food poisoning,
* Ulcerative colitis,
* Crohn’s disease
* celiac etc

Diagnosis of Bloody mucus stool:-

History collection reveals presence of any diseases, colour of blood, pain is present or not, etc. And feeling any mass in the rectum also helps in easy diagnosing. After diagnosis, treating the underlying cause, blood and mucus in the stool can be stopped.

Definition of Anemia:-

Anemia can be defined as medical condition in which decrease in the red blood cell or hemoglobin less than 13.5 gm% in males and 12 gm% in females.

Causes of anemia:-

* Anemia caused due to blood loss
* Anemia caused due to decreased or fault in the bone marrow
* Anemia caused due to abnormal destruction of red blood cells in the spleen and liver
* Anemia Caused due to Blood Loss
* When the blood loss occurs due to severe hemorrhage, there is loss of red blood cells leads to anemia.
* Alimentary canal conditions such as ulcers, files, gastritis (inflammation of the stomach) and cancer
* Prolonged Use of non steroidal anti-inflammatory drugs (NSAIDS) such as paracetamol, aspirin etc, causes anemia.
* Menstruation and during delivery, especially if menstrual bleeding is more than normal, antepartum hemorrhage. Postpartum hemorrhage and if there are multiple pregnancies also causes anemia.
* Severe blood loss in case of injury causes anemia.
* Anemia Caused due to fault in the bone marrow production of red blood cells

Anemia occurs due to following reasons:-

#  Sickle cell anemia is also called as hereditary anemia

#  Iron deficiency anemia due lack of iron in the food and lack of absorption in the gut

#  Vitamin deficiency such as vitamin c and vitamin B

#   Bone marrow and stem cell problems that is due to carcinoma

Anemia Symptoms:-

The symptoms of the anemia includes the following:-

* Fatigue
* Rapid heart rate
* Heart murmur
* Enlargement of the spleen
* Low blood pressure
* Abdominal pain
* Weakness Rapid breathing
* Maroon, or visibly bloody stools
* Trouble breathing
* Dizziness
* Pale or cold skin
* Tired
* Palpitations
* Hair loss,
* Malaise
* Worsening of heart problems

Diagnosis of Anemia:-

* Complete blood count (CBC)
* Red blood count
* Hemoglobin
* Hematocrit
* White blood count
* Platelet count
* Differential count
* Means corpuscular volume
* Stool guaiac – Tests for blood in stool
* Peripheral blood smear – Looks at the red blood cells under a microscope
* Transferring level – Looks at a protein that carries iron around the body
* Reticulocyte count
* Bone marrow biopsy
* These are the tests done for diagnosis of anemia.

Anemia Treatment:-

Care at Home:
1. Anemia can be treated at home by providing iron rich diet, adequate bed rest and by taking iron and folic acid tablets etc.
2. If the patient is having stomach ulcer he or she as to stop taking aspirin and medications such as ibuprofen etc.

Medical Treatment of anemia:

Oral therapy for anemia:-  The medical treatment includes iron and folic acid tablets, oral solutions like ferrous fumarate and ferrous gluconate etc.

Parenteral therapy for anemia:

Intravenous injections: -  It includes administration of the iron injections through intravenously for sudden onset of action, and used to treat severe anemia.

Intramuscular injections: – Here injections are given in a Z track method and it is effective but having more side effects.

Blood transfusion for anemia : – In case of severe anemia the packed cell are transfused.

Oxygen – To ensure that each red blood cell can deliver the maximum oxygen to body tissues

Fluids – To help to elevate blood pressure when blood loss causes blood pressure to drop

Platelets – Replaces missing platelets when bleeding is severe Antibiotics are given to treat infections.

Erythropoietin is given to improve the red blood cell production. Surgery for anemia treatment includes Hysterectomy that is removal of the uterus will help to prevent the loss of the bleeding after the delivery and due to any carcinoma.

Follow-up care in anemia

Follow up care in anemia is very essential to prevent further occurrence of the anemia, it includes the regular check up, and continuation of the medications.

Prevention of anemia:-

Prevention of anemia can be achieved by regular check up and by early detection of the anemia and treatment. And taking iron rich diets like drumstick, green leafy vegetables, papaya, cereals and milk and milk products helps in preventing anemia.

Complications of anemia : Complications of the anemia includes the hypoxia, cardiac problems like cardiac failure, tissue hypoxia and brain anoxia.

Throat cancer is the malignancy of the throat, it may be the presence of tumor in pharynx or in the larynx. Some of the common symptoms include the lump or the sore that does not heal for the long time, there will be chronic cough, dysphagia will be present for long time, and there will be hoarseness in the voice which not resolves in 1 or 2 week.

The throat cancer symptoms sometimes may be due to some other reasons will be often confused with the throat cancer symptoms so there should be proper diagnosis and treatment should be given. And the doctor must collect the history of all the symptoms.

General throat cancer symptoms:-

* Epistaxis
* Chronic earaches
* Pain in the upper teeth
* Headaches
* Swelling in the eyes
* Chronic sinus infections that do not go away when treated with antibiotics
* Blocked sinuses that will not clear
* Sore throat that not decrease for weeks even antibiotics are administered is main throat cancer symptoms.
* There will be sudden unexplained weight loss
* Coughing of blood
* Breath sounds will be high pitched
* Blood-flecked phlegm.
* The sensation of something permanently stuck in the throat as a throat cancer symptoms.
( Gastrointestinal disorders )
* Excessive reflux, diarrhoea or constipation
* Enlarged lymph nodes
* Disfigurement of face
* Deformities in skin and other
* Throat Cancer Symptoms that are very prominent.
* There is a presence of Numbness or paralysis of facial muscles
* There will be chronic Facial pain associated with throat cancer symptoms.
* Long duration neck pain is also a throat cancer symptoms.

Diagnosis of throat cancer:-
If there is presence of all the above throat cancer symptoms the patient should undergo immediately some diagnostic measures to confirm the throat cancer. The diagnostic test includes the following.

• Laryngoscopy :there is lighted camera in a tube is introduced in to the throat and the throat is examined for the presence of the tumor or malignancy is used to diagnose throat cancer symptoms.

• CT scan of the cranium should be done or the cranial MRI can be done to confirm the cancer that spread to the lymph nodes, is used to diagnose throat cancer symptoms.

• Biopsy is the collection of the tissue from throat to confirm with the tumor cells. Under microscopic examination of this cell will reveal the cancer cells, is used to diagnose throat cancer symptoms.

Rabies can be defined as  ‘ A fatal viral infection, is usually acquired through the bite of an infected animal to the human beings’. Nearly all morbidity in human beings worldwide is due to the bite of a rabid dog, and rabies infection. The rabies occurs from the rabdo virus. Rabies vaccine has reduced the incidence of rabies morbidity.

Rabies vaccination is the active immunizing agent  used to prevent the infection caused by the rabies virus that carried by the animals. It is a killed rabies virus vaccine.

There are two types of rabies vaccinations:-

1. Pre-exposure prophylaxis : this type of rabies vaccination is done for the persons who are at high risk of getting infected. Animal handlers, veterinarians, travelers, the persons who are in contact with the wild animals are likely to get infected.
2. Post-exposure prophylaxis : this type of rabies vaccination prophylaxis is done to the patients who are exposed to the animal bites, indicated by bite, scratch, or lick.

Facts related to rabies vaccine:-

* The rabies  spreads through the pet animals as well as wild animals; dogs, bats, raccoons, skunks, cats, horses, swine, foxes and cattle are the usual ones. So it is better to immunize the domestic animals with rabies vaccine.
* A person who is bitten by the infected animal  should receive the rabies vaccine after the animal bite. If patient is known to be hypersensitive to the rabies vaccine, then the rabies vaccine should be administered under supervision with all the immediate measures for managing anaphylactic shock.
* Prophylactic use of the rabies vaccination should be avoided in children, adolescents, antenatal mother & adults on treatment for any acute illness.
* Pre exposure rabies vaccine is to be avoided if person is known to be allergic to rabies vaccine.
* The further rabies vaccination or  immunization is avoided in persons who had complications on rabies vaccine administration.

The immunization schedule is classified under some grades as:-

* Grade I : when the person is in contact with the animal but not in contact with the saliva or blood. For this kind scheduled rabies vaccination is not needed.
* Grade II : If the animal has licked or if any other kind of expose to the saliva and superficial, non- bleeding scratches made by the animal, immediate rabies vaccine immunization should be given according to the schedule B.
* Grade III :  includes all bites, bleeding scratches, all wounds on the head, neck, scapular region, extremities. Direct contact of animal saliva with mucous membrane of patient, immediate concomitant prophylaxis with rabies vaccine is needed according to schedule C.

The classification according to severity of expose to animal:-

Schedule A: In this type one injection of rabies vaccine of Prophylactic immunization prior to exposure is given. One injection is given IM on days 0,7,28 and 365.

Schedule B: Immunization vaccine  should be given after exposure but it is of somewhat long  coarse. One injection of  rabies vaccine IM is given on days 0,3,7,14,30 & if necessary it is given on day 90.

Special precautions for rabies vaccine administration:-

The person who has received rabies vaccine of doubtful potency and who has discontinued the course of injections has to receive the entire course of rabies vaccine according to exposure.  In case the person is re-exposed after 5 yrs., entire course should be completed according to grade of exposure.

Dosage and administration of rabies vaccine:-

There is no difference in the dose for children & adults. 1ml of rabies vaccine is given by intramuscular injection in the deltoid muscle (arm) or in the thigh in small children. The prescribed schedule should be followed strictly  even if some time has passed since the exposure.

rabies vaccine side effects:-

* This rabies vaccine doesn’t cause that much vital side effects, but it will cause generally mild and non serious side effects.
* There will be a mild pain, redness and swelling may occur at injection spot as a side effect.
* Rarely arthritis, gastrointestinal disorders or lymph node swelling may occur as  rabies vaccine side effects.
* Sometimes anaphylactic shock may occur.

Contraindications for rabies vaccine:-

If there are hypersensitivity reactions to the vaccine or acute febrile illness the rabies vaccine is contraindicated for pre-exposure prophylaxis. In case of pregnancy vaccine should be given if the level of risk is high for pre-exposure prophylaxis.

Definition:-

Fever can be defined as elevation of the body temperature more than usually by about 1-2 ° above the normal 98.6 degrees Fahrenheit (F) or 37 degrees Celsius (C). Fever is not a disease and is a symptom and it differs from hyperthermia.

Causes of fever:-

* Viral or bacterial Infections : influenza, common cold, Human immunodeficiency virus, malaria, infectious mononucleosis, or gastroenteritis, strep throat, pneumonia, flu and chickenpox, Endocarditis, Encephalitis and Meningitis Gastroenteritis (Stomach Flu), Melioidosis, Staph Infection (Staphylococcus Aureus) , Respiratory Syncytial Virus, and other infections causes fever.
* Various skin inflammations : boils, pimples, acne, or abscess cause fever.
* Immunological diseases : lupus erythematosus, sarcoidosis, inflammatory bowel diseases also cause fever.
* Tissue destruction : which can occur in hemolysis, surgery, infarction, crush syndrome, rhabdomyolysis, cerebral hemorrhage, etc cause fever.
* Drug fever : is directly caused by the drug, e.g. lamictal, progesterone, or chemotherapeutics causing tumor necrosis.
as an adverse reaction to drugs, e.g. antibiotics or sulfa drugs.
* After drug discontinuation, e.g. heroin or fentanyl withdrawal
Cancers : most commonly renal cancer and leukemia and lymphomas leads to fever as a first  symptom.
* Metabolic disorders : gout or porphyria also causes fever.
* Thromboembolic processes : pulmonary embolism or deep venous thrombosis

Symptoms & Signs of fever:-

* Increase in body temperature more than 100.4 degrees F (38 degrees C) is main sign of fever.
* presence of chills due to increase in temperature of the body than the external environment is associated with fever.
* Increase in heart rate and muscle tone is the main symptom of fever.
* Shivering will be there.
* In severe cases of fever sometimes there will be presence of delirium and convulsions. Delirium and convulsions  are usually seen in children.
* When there is rise in body temperature patient feels warm. If fever reduces the person may start to sweat.
* Severe cases of fever will be associated with some other symptoms at that time the patient has to meet the doctor immediately to treat fever.

Measurement of fever:-

The fever is measured using an instrument called thermometer. It contains mercury in it. The instrument is placed in different parts of the body and the temperature can be measured. There are varies types of thermometer are there. They are

* oral thermometer,
* axillary thermometer and
* anal thermometer.

If the temperature is taken in the anal region we have to subtract 1 degree from the total temperature because there is always high temperature in there.
If the temperature is measured in the oral region it is the normal there is no need of adding or subtraction.
When we are taking temperature in the axillary route we have to add 1 degree

classification of fever:-

fever is classified according to the grade of temperature, they are

* Low grade fever : approximately varies from 100.4-102.2 degrees of F
* Moderate fever : approximately varies from 102.2-104.0 degrees of F
* High grade fever : approximately varies from104.0-107.6 degrees of F
* Hyperpyrexia : is the maximum level that is more than the 107.6 degrees of F

advantages of fever:-

* According to some studies the fever is essential for the immune bodies to fight against the antigen of bacteria. it speeds up certain immunological reactions.
* Fever may be sometimes very essential in some extents because it cause unbearable environment for the pathogens.
* Fever is useful for the immunological bodies, it provides favorable environment for the white blood cells, so they will proliferate easily and can fight against the pathogens. There will be increased activity during fever.

Treatment for fever:-

* Fever is not treated essentially because it is a essential reaction of our body. So the fever needs only the symptomatic management. There will be so much of dehydration so the patient should be hydrated properly with intravenous fluids.
* During fever period the patient may be disoriented, so the patient needs psychological support to recover from fever, nurse should give psychological assurance that fever will be get reduced as soon as possible.
* The fever patient needs complete bed rest, and room should be well ventilated and provide an environment to sleep well.
* Feed the fever patient only with small, frequent diet, because there will be alteration in the bowel pattern and indigestion may occur.
* The immediate cause of the fever should be found and proper steps to be taken to reduce fever.
* There will be chances of hyponatremia, the patient is given sports’ drinks or intravenous administration of the electrolytes.
* If the fever is so high, cold bath or tepid sponge bath should be given.
* If the fever remains same the patient must take antipyretics like paracetamol or ibuprofen, Aspirin etc.
* The actual reason for fever should be find out and the cause should be treated immediately.

First pregnancy symptoms:-

Every women on this world likes to be mother. Most of the women becomes very happy as soon as they come to know, they are pregnant. As the lady going to create the new life in her own womb.

Even though the happiness is very high during first pregnancy, some fear also arises in the mother. Labour process or the child birth process may create some fear in women. The responsibility of women as a mother also may cause stress to the mother.

Helpful facts about pregnancy:-

* women should be happy as you are becoming mother.

* Don’t get fear about childbirth or Labour after First pregnancy.

* Millions of mothers have given birth to their child and your mother also.

* Even though some pain is present in first labour, when you see the baby you will forget all worries of first pregnancy and child birth process.

* Know about symptoms of pregnancy and don’t think even a small health deviation as disease.

* Read good books during first pregnancy to get healthy baby.

* Don’t be bored with your First pregnancy and be active.

* Eat fruits and vegetables, enough to maintain good health of both First pregnant mother and growing fetus.

* Avoid smoking and stop alcohol during pregnancy.

The symptoms of first pregnancy:-

* Missed period,
* Morning sickness or nausea,
* Abdominal bloating,
* Dark areolas,
* Tender and swollen mammary gland,
* Headache,
* Fatigue, and tiredness,
* frequent urination etc.  .