SIMPLE WAYS TO OVERCOME STRESS: TIPS FOR EFFECTIVE MANAGEMENT 2

Eat right:

Eating a good balanced diet every day is very important to avoiding stress of body, soul and mind. Foods rich in vitamins like eggs, meat, legumes and vegetables rich in iron and other trace mineral elements like zinc, manganese etc. are all essential body building elements necessary for good physical, mental and emotional stability necessary for stress reduction. Where the raw food materials cannot be easily obtained for whatever reason then food supplements in form of tablets or caplets may be taken with the available food. But it is better if the raw food materials can be cooked and taken, instead of synthetic food supplements.

Get organized, so everything has its place:

Organizing yourself in terms of physical, mental and emotional components is very important to reducing stress. Dotting your ‘I’s and crossing your ‘T’s and putting square pegs in square holes and round pegs in round holes is very important. Also, try to do the right things at the right time, in the right way and in the right place. This brings peace of mind and a relaxed composure at all times.

Every day, find time to be alone:

This gives you opportunity to look at things in retrospect and possibly make corrections and adjustments. Also you get to appreciate the Almighty creator of the universe, life and living.

Make friends with happy, non-stressed people:

Like attracts like. When you associate with such people you learn from them and their non-stressed nature rubs on you easily.

Laugh:

Laughter is a good antidote for stress and engaging in activities that engineer laughter will bring relaxation and fun. So try and watch comedies and play games that make you laugh a lot. You will discover that your stress level falls significantly when you engage in these laughter-fun activities.

Laugh some more:

You cannot have too much of it and even if you do, it will be for the best.

Take your work seriously, but yourself not at all:

Learn to prioritize your work activities and leave your ‘work’ at the work place. Do not indulge in the habit of carrying work files home. Spend ‘quality time’ with your family every day except maybe when you are out of town. Make sure you engage your family members in fun activities that bring everyone joy and laughter. RELAX and be yourself.

Remember that the shortest bridge between despair and hope is often a good night’s sleep:

The benefits of good sleeping habits cannot be over emphasized. Make sure you apportion adequate time for sleep. If possible try and go to bed early on days when your work duties seem to have stressed you more than usual. If you are having regular sleep problems, you may need to see your physician for help.

Be kind to unkind people (they probably need it the most):

This is one of the attributes of good neighborliness and when practiced gives you peace of mind and relaxation most times.

K.Y.M.S. (Keep Your Mouth Shut). This single piece of advice can prevent an enormous amount of trouble:

This is very good advice and most times SILENCE is golden. If you must speak be careful about what you utter. Always choose your words carefully. In essence, be a good listener and less of a talkative. Heeding this advice will greatly reduce your tension, hence your stress.

Author: Ola Suyee    

SIMPLE WAYS TO OVERCOME STRESS: TIPS FOR EFFECTIVE MANAGEMENT - PART 1

SIMPLE WAYS TO OVERCOME STRESS: TIPS FOR EFFECTIVE MANAGEMENT - PART 1

Going to bed on time:

This is one of the most important areas of living that needs to be properly attended to if one is to overcome stress. Taking a light beverage coco drink an hour or more before retiring to bed could help ‘deepen’ your sleep. Engaging in relaxing activity like watching telly, playing games, reading etc., just before going to bed could also be helpful in ensuring you have a sound sleep. Generally, things that bring you joy and make you happy should be done before going to bed at all times. NEVER GO TO BED ANGRY, QUARRELING OR HAVING NEGATIVE THOUGHTS. You are likely to have a disturbed sleep and possibly, nightmares which, on waking up will certainly lead to a stressful and unfulfilled day.

Get up on time, so you can start the day unrushed:

When you go to bed on time you are also likely to get up on time to organize your day, dot your Is’ and cross your Ts’ before engaging the days duties in earnest.

Delegate tasks to capable hands:

You must learn the art of delegating duties/tasks to capable hands and make sure each one gives you adequate feedback or progress report regularly till the task is successfully completed. Trying to do everything by yourself and be everywhere at the same time, only leads to serious stress and poor results. Essentially, this is a sign of poor managerial skill and bad leadership quality. Try as much as possible to avoid overloading yourself with work. Make effective use of your subordinates and where you do not have subordinates, then learn to prioritize your duties; executing the most important ones’  first.

Simplify and unclutter your life:

Make sure you set attainable goals for yourself, and prioritize your tasks. This will help simplify things and get you properly organized both in your thinking and in your actions. An organized life makes living, simple and beautiful and is the panacea for success.

Take one day at a time:

Learn not to rush things or be too eager about doing things. Just take things in their stride as they come along. Do not worry about tomorrow. Let tomorrow take care of itself.

Separate worries from concerns:

This is another area where prioritizing becomes very useful. You should find solution to your worries before your concerns. Once you have been able to identify those areas of worry as different from those giving you concern, set in motion machinery to bring visible change and solutions to the worrisome areas while the areas of concern also get some reasonable attention for improvement. It should be a continuous evaluation process. 

Get enough exercise:

Subjecting your body to a certain amount of controlled stress through exercise helps to keep you balanced, relaxed and fit to take on each day and its challenges with ease and certainty for success.I assure you, nothing can replace a good workout in the gym or at home, in your house. Make sure you devout at least 30 to 40 minutes every day to a good workout routine that makes you sweat and burn some calories.

Author: Ola Suyee

 

Diarrhoea and Vomiting (D&V) – Some Common Causative Agents and Their Management (Part 3)

Diarrhoea and Vomiting (D&V) – Some Common Causative Agents and Their Management (Part 3)

Antibiotic Associated Diarrhoea (Clostridium difficile Infection):

A history of any antibiotic therapy in the 6weeks prior to the onset of diarrhoea can be related to the finding of Clostridium difficile or its toxins in the stool.

This is a potent cause of diarrhoea and can produce life threatening pseudomembranous colitis.

This diagnosis is common in the elderly and treated often with metronidazole (Flagyl) for 10days.

Vancomycin may be used where the organism is unresponsive to metronidazole.

Cholera:

Aetiology & Epidemiology:

Cholera is caused by Vibrio cholera, a bacterium. Serotype 01 causes acute watery diarrhoea plus vomiting.

Following its origin in the Gangs valley, devastating epidemics have occurred, especially during large religious festivals.

Pandemics have spread worldwide.

The 7^th pandemic due to the El Tor biotype began in 1961 and spread via the Middle East to become endemic in Africa.

In 1990 it surfaced in Peru and spread throughout South and Central America.

Since August 2000, there has been a massive outbreak in South Africa.

The El Tor biotype is more resistant than the classical vibrio and can cause prolonged carriage in about 5% of infections.

A new classical toxigenic strain, serotype 0139, established itself in Bangladesh in 1992 and started a new pandemic.

Mode of Infection/Transmission:

The infection spreads via the stools and vomitus of symptomatic individuals or through the much larger number of subclinical cases (asymptomatic carriers).

Transmission is through infected drinking water, foods contaminated by flies or through the hands of carriers.

The vibrio microorganism survives for up to 2weeks in fresh water and 8weeks in salt water.

Signs and Symptoms (Clinical Features):

Severe diarrhoea starts all of a sudden without abdominal pain or colic and is soon followed by torrential vomiting.

After evacuation of normal gut faecal contents typical “rice water” stools follow consisting of clear fluid with flecks of mucous.

Classical cholera produces enormous loss of body fluids and electrolytes leading to intense dehydration with muscular cramps. Shock and oliguria develop but mental alertness remains.

Death from acute circulatory failure may occur rapidly unless fluids and electrolytes are replaced quickly. This is why the disease is more dangerous in children.

Improvement however is rapid with proper treatment.

It is to be noted however, that majority of infections cause mild illness, with slight diarrhoea and vomiting.

Occasionally, a very intense illness “cholera sicca” occurs, with massive loss of fluids into dilated bowel, killing the patient before typical gastrointestinal symptoms appear.

Diagnosis:

Clinical diagnosis is easy during an epidemic.

At other times, diagnosis is confirmed bacteriologically from rectal or stool swab cultures.

*Cholera is a notifiable disease under international health regulations.

Treatment/Management:

Quick, early restoration of the circulation by replacement of water and electrolytes is very important and is the key to survival.

Early intervention improves the prognosis.

Oral rehydration solution (ORS) is effective and safe where vomiting has been controlled by initial intravenous fluid therapy.

The addition of resistant starch to ORS reduces faecal fluid loss and shortens the duration of diarrhoea in adolescents and adults.

Total fluid requirements may exceed 50litres over a period of 2–5days. Ringer lactate is the best fluid for intravenous replacement.

Careful attention to fluid balance is especially important in children and they are prone to low blood sugar (hypoglycaemia) during the illness.

3-5days treatment with Tetracycline, or Doxycycline or Ciprofloxacin in adults and children helps to reduce the duration of excretion of vibrio and the total volume of fluids needed for replacement.

*Children should not be given Tetracycline because of discolouration of their dentition.

Prevention:

-         Strict personal hygiene

-         Clean drinking water (pipe borne or boiled)

-         Proper food hygiene to deny flies access.

-         Parental and oral vaccines provide limited protection (6months at most)

-         In epidemics, mass single dose vaccination and treatment with Tetracycline are valuable.

-         Public education, control of water sources and population movement are very important.

-         Disinfection of discharges and soiled clothing.

-         Meticulous hand washing by medical personnel reduces danger of spread.

Author: Ola Suyee

Diarrhoea and Vomiting (D&V) – Some Common Causative Agents and Their Management (Part 2)

Diarrhoea and Vomiting (D&V) – Some Common Causative Agents and Their Management (Part 2)

Travellers Diarrhoea (TD): 

This is classically defined as passage of three or more unformed stools within a 24 hour period during or shortly after a period of foreign travel.

It is frequently encountered by individuals travelling to developing countries.

Aetiology:

Most common cause of TD is the ingestion of faecally contaminated food or water.

A number of bacterial, viral, and parasitic organisms can cause TD, but the majority of cases are associated with bacteria, particularly the pathogen enterotoxigenic Escherichia coli (ETEC).

Here is a list of the most common causes of TD:

(1)  Enterotoxigenic E.coli

(2)  Shigellosis spp.

(3)  Camphylobacter jejuni

(4)  Salmonella spp.

(5)  Pleisonias Shigelloides

(6)  Non-Cholera Vibrio spp.

(7)  Aeromonas spp.

Pathogenesis: 

The organisms produce either a heat-labile or a heat-stable enterotoxin, causing marked secretory diarrhea and vomiting after 1- 2 days incubation.

Treatment: 

(a) If diarrhea is associated with severe dehydration, intravenous fluid and electrolyte replacement is indicated.

This is of particular importance in the case of diarrhea associated with Vibrio.

(b) Antibiotics: These can be used to limit the duration of symptoms and prophylaxis may help to prevent the disease.

(c) In most cases the illness is usually mild and self-limiting after 3 – 4days. Most important supportive treatment is fluid and electrolyte replacement; either orally (if there is no vomiting) or intravenously if there is.

Campylobacter jejuni:

Aetiology and Pathogenesis:

This infection is basically a zoonosis (a disease of animals that may secondarily be transmitted to man). The organism inhabits the gut of cattle and poultry, the commonest source of infection being chicken or contaminated milk.

There is also an association with pet puppies.

Campylobacter infection is now the most common cause of bacterial gastroenteritis in the U.K., even though most of the cases are sporadic.

The incubation period is 2–5days.

Clinical Features & Treatment:

Severe colicky abdominal pain which mimics surgical pathology at times ensues and is followed by nausea, vomiting and quite significant diarrhoea which may become blood stained as the illness progresses.

Majority of Campylobacter infections affect fit, young adults and are self-limiting after 4-7 days.

10-20% will have prolonged symptomatology warranting treatment with antibiotics such as ciprofloxacin or a macrolide, while another 1% of cases will develop bacteraemia and distant foci of infection.

Author: Ola Suyee

  

Diarrhoea and Vomiting (D & V) - Some Common Causative Agents and Their Management (Part 1)

Diarrhoea and Vomiting (D & V)-Some Common Causative Agents and Their Management (Part 1)

 Salmonellosis (Typhoid Fever)

CAUSATIVE AGENT(S):

Salmonella typhi and paratyphi A, B, C.

The disease is prevalent in the Far East, Middle East, South and Central America, Africa, Southern and Eastern Europe.

Th

SOURCE OF INFECTION:

 Both types have a purely human reservoir and infection is through faeces or urine of a patient or carrier.

Water and Food are important vehicles for spread of the infection, particularly poultry, egg products and related fast foods.

Direct person to person spread or the handling of exotic pets such as salamanders, lizards, or turtles are also common mode of contacting the disease.

Any age group may be affected but the highest incidence of disease is in the young adult. Babies seldom have the disease; when they do it is often mild and atypical.

These two serotypes produce septicaemic illness ‘enteric fever’ (Typhoid or Paratyphoid fever)

*All other Salmonella serotypes, of which there are more than 2000, are subdivided into five distinct subgroups which produce gastroenteritis (diarrhea and vomiting).

They are widely distributed throughout the animal kingdom. Some strains have a clear relationship to particular animal species, e.g.S.arizonae and pet reptiles.

CLINICAL PICTURE:

  

Incubation period of Salmonella gastroenteritis is 12-72 hours with an upper limit of about 7 days.

Onset of illness is usually insiduos.

SIGNS & SYMPTOMS:

Headache, malaise, and abdominal discomfort. – Slight abdominal distention may occur. – Persistent cough and epistaxis (bleeding from the nose) may occur by the 2^nd week.

Temperature remains high and diarrhea and vomiting develops.

Patient is weak and listless.

Spleen is often enlarged and palpable and characteristic rashes may appear on the abdomen, face and chest. (called Rose Spots)

These may not be visible on a pigmented skin. The patient may become delirious, confused and may lapse into coma as the disease progress.

CARRIER STATE:

Carriers are people who are infected with the Salmonella organism but do not manifest symptoms of the disease.

TWO TYPES:

Faecal Carriers,          - Urine Carriers – rare

TREATMENT;

Ciprofloxacillin is the drug of choice.

Dose: 500mg every twelve hours in adults and treatment is for 10 to 14 days.

Children – 25mg/kg body weight.

Other drugs that can be used are:

--SEPTRIN   --AMOXYCILLIN  --CHLORAMPHENICOL  --PERFLOXIN

TREATMENT OF CARRIER STATE:

Ampicillin 3g/day in divided doses x 3months.

Septrin ii twice a day x 1month.

PREVENTION:

1. (a) Provision of pure water supplies.

   (b) Safe sanitary disposal of excreta.

   (c) High standard in handling, processing and storage of

       food

       Food handlers have to be monitored regularly.

2. Typhoid vaccine – 2 s/c injection (0.5mls) given 4wks

   apart.

   Boosters every 3years – (0.1ml)

3. Patients should be placed under surveillance and regular   

   Stool and urine tests done to detect carrier state.

4. Identified carrier should be prevented from engaging in   

   food handling.

   Counsel on proper personal hygiene is important

Staphylococcal Food Poisoning:

CAUSATIVE AGENT:

Staphylococcus aureus is a common commensal of the anterior nares of humans and with poor hygiene transmission takes place via the hands of food handlers to foodstuffs such as dairy products, (milk, cheese, eggs) and cooked meats.

Inappropeiate storage of these foods allows rapid multiplication of the organism and subsequent production of one or more heat-stable enterotoxins which are the real culprits in the manifestation of the signs and symptoms of food poisoning.

SIGNS AND SYMPTOMS:

After ingestion, symptoms of nausea and profuse vomiting develop within a couple of hours (1-5hrs). Diarrhoea may not be as severe as the vomiting at times. The main pathological agent is the toxin(s) which acts on the gastrointestinal cells pulling in water and electrolytes into the intestinal lumen making the diarrhea and vomiting severe. Most cases settle rapidly but severe dehydration and rare fatalities have been known to occur due to acute fluid loss and shock.

DIAGNOSIS:

The mainstay of diagnosis is to demonstrate the toxins in stool and to culture the organism from same. Where any suspect food is available it should be cultured for staphylococcus and demonstration of toxin production.

 TREATMENT:

Antiemetic drugs with appropriate fluid replacement are the mainstay of treatment with some antibiotic to prevent opportunistic infection.

PREVENTION:

Public health authorities should be notified if food vending is involved.

Food handlers should be taught how to practice good hygiene and the populace as well.

N.B.

I have tried to discuss here in simple form the sort of emergencies seen from ingestion of contaminated food or drink. Though the individual is not expected to institute any treatment per se, recognition of the signs and symptoms should make the individual seek medical attention as quickly as possible. Part 2 will follow soon.

Author: Ola Suyee