Salmonella typhi and Salmonella paratyphi most commonly cause typhoid, or enteric fever, in which an acute febrile illness is preceded by ingestion of the organism and a short course of diarrhea, which resolves before the onset of fever. Non-typhoidal Salmonella, however, is the most common cause of food-borne diarrhea, transmitted via contaminated meats, poultry, eggs, and dairy products. Food handlers can be reservoirs. Rarely, outbreaks are water-borne or from Pet reptiles, which are frequently carriers. Patients with non-typhoidal illness often present with nausea, vomiting, and diarrhea 6 to 48 hours after ingestion of contaminated food. Abdominal pain and fever are common, but bloody stools occur less frequently. Stool examination reveals leukocytes, and routine cultures will be positive in 58% of cases.Most cases of gastroenteritis resolve without treatment in 3 to 7 days.Symptoms of colitis may persist for several weeks. Treatment can prolong the fecal excretion of organisms and should be avoided in mild cases. Antibiotics should be given to patients with severe symptoms, at extremes of age, with immunosuppression, with cardiovascular disease, or with a prosthesis, as the organism has a propensity to infect vascular aneurysms and prosthetic joints. Carriage of non-typhoidal salmonella can persist for 4 to 5 weeks after resolution of diarrhea. Fluoroquinolones, ampicillin, and trimethoprim-sulfamethoxazole are acceptable agents to treat Salmonella infection. Length of treatment is usually 1 week, but if the patient is bacteremic or focally infected, longer courses are necessary.*67/348/5*
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DIAGNOSING CHILDREN WITH EPILEPSY
Comments OffThere are special difficulties in diagnosing the child with epilepsy. Children, and especially adolescents, do behave strangely at times. At school, children with absence seizures may be accused of day-dreaming or lack of concentration, considered disobedient or inattentive. In adolescents especially, the irrational and sometimes truculent behaviour associated with partial complex seizures is often mistaken for a disorder of behaviour.But equally, there are serious consequences for the child if he or she is mistakenly diagnosed as having epilepsy when what they are actually suffering from is some other episode of disturbed behaviour. Breath-holding attacks and night terrors in young children, temper tantrums, fainting in school assembly and migraine are all sometimes confused with epilepsy.One of the most difficult things about epilepsy is its unpredictability and uncertainty. Even when your child has been diagnosed as having epilepsy, it may take some weeks before the pattern of their fits has been worked out, and the best medication for them has been found. You will want to know what the long-term prospects are for your child, and whether he or she will outgrow their epilepsy, and these are predictions that your doctor may be reluctant to make straight away. If there is a strong family history of epilepsy, the chances are good that your child will improve after adolescence or even that they will outgrow their epilepsy by the time they are 16.*66\193\2*
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VACATIONS – ADVICES (PART 2)
Comments Off• Drink lots of water during your vacation.• Check out the local dishes, especially if your vacation is in a foreign country. If they are fried, dipped in batter, sugary, or salty —avoid them. If they are fresh, natural, light, and still tasty— enjoy. If you try a national dish that turns out to be covered in sauce, gravy, or cream, pick out the chunks without sopping up the sauce. Avoid raw foods and tap water in foreign countries. Fresh fruits that can be peeled or husked are okay.• Lay off the bread products, no matter how good.• Stop at grocery stores and outdoor markets for fresh foods, rather than at roadside restaurants or greasy spoons. A rotisserie chicken, some carefully chosen cheese (Laughing Cow makes a reduced-calorie cheese that is only 35 calories per three-quarter-ounce triangle), and fresh fruit will make a much better meal than one eaten at a fast-food restaurant. It’s no harder to get off the freeway to stop at a supermarket than it is to get to a restaurant. Most major cities in America (and around the world for that matter) have markets that are tourist attractions—pay them a visit and enjoy.More and more, there are vacation spots that advertise low-calorie fare, exercise programs, and overall health benefits. There is a Club Med vacation where a doctor will check you out and tell you exactly what to eat. There are sports-oriented vacations: tennis camps, rafting trips, climbing trips, trekking, and so forth. You can get away from it all, have a great time, and come home thin.*144/243/1*