Neonatal Jaundice

Yellow babies, imagine you walk in postnates, NICU or Neonates triage and you encounter a yellow baby or rather a mother complains of her baby being yellow. How would you react? What would be the next action you gonna take?

A liver condition that causes yellowing of a newborn baby's skin and eyes.

Neonatal jaundice is common in preterm babies. The cause is often an immature liver. Infection, medication or blood disorders may cause more serious cases.

This late-onset jaundice may develop in up to one third of healthy breastfed infants. 1 Total serum bilirubin levels vary from 12 to 20 mg per dL (340 μ mol per L) and are nonpathologic.

What causes jaundice?

The yellow color of newborn jaundice is caused by high levels of a substance called bilirubin in the blood. Bilirubin mostly comes from the breakdown of red blood cells. It gets processed in the liver to make it easier for the body to get rid of through the urine and stool.

What are the symptoms of Neonatal Jaundice?

Your baby's skin becomes more yellow. The skin on your baby's the abdomen, arms or legs looks yellow. The whites of your baby's eyes look yellow. Your baby seems listless or sick or is difficult to awaken.

Risk factors of Neonatal Jaundice

• Premature birth. A baby born before 38 weeks of gestation may not be able to process bilirubin as quickly as full-term babies do.
• Significant bruising during birth.
• Blood type.
• Breast-feeding.

• Race.

Types os neonatal jaundice

Pathophysiology.

Jaundice results from high levels of bilirubin in the blood. Bilirubin is the normal breakdown product from the catabolism of haem, and thus is formed from the destruction of red blood cells. Under normal circumstances, bilirubin undergoes conjugation within the liver, making it water-soluble.

Management

Treatments to lower the level of bilirubin in your baby's blood may include: 

• Enhanced nutrition. To prevent weight loss, more-frequent feeding or supplementation to ensure that your baby receives adequate nutrition. 
• Light therapy (phototherapy).

Pathologic jaundice 

The most serious type of jaundice. It occurs within 24 hours after birth, and is characterized by a rapid rise in a baby's bilirubin level. The most likely cause is blood incompatibility or liver disease. Prompt medical attention is necessary, and blood transfusions may be required.

Management 

If bilirubin levels necessitate it, treatment for jaundice involves phototherapy and/or exchange transfusion of  blood. In cases of pathological jaundice the underlying cause must also be treated. Parental involvement is important to minimise the trauma of having a sick baby and its effect on bonding.

Phothotherapy

Phototherapy is a medical treatment in which natural or artificial light is used to improve a health condition. Treatment could involve fluorescent light bulbs, halogen lights, sunlight, or light emitting diodes (LEDs). Phototherapy is also known as light therapy and heliotherapy.

Phototherapy is treatment with a special type of light (not sunlight). It's sometimes used to treat newborn jaundice by lowering the bilirubin levels in your baby's blood through a process called photo-oxidation. Photo-oxidation adds oxygen to the bilirubin so it dissolves easily in water.

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Birth injuries

 Cephaloheamatoma

Cephalohematoma (seh-FEL-low HE-muh-toe-muh) is blood that collects between a newborn's scalp and skull. Hematoma means blood that pools outside blood vessels. Cephalo refers to the head. This type of birth injury occurs when pressure on a baby's head ruptures blood vessels in the scalp.

What is the cause of cephalohaematoma?

The cause of a cephalohematoma is rupture of blood vessels crossing the periosteum due to the pressure on the fetal head during birth. During the process of birth, pressure on the skull or the use of forceps or a vacuum extractor rupture these capillaries resulting in a collection of serosanguineous or bloody fluid.

Sign of a cephaloheamatoma

The most obvious sign of a cephalohematoma is a soft, raised area on the newborn's head. A firm, enlarged unilateral or bilateral bulge on top of one or more bones below the scalp characterizes a cephalohematoma. The raised area cannot be transilluminated, and the overlying skin is usually not discolored or injured.

The hallmark symptom of a cephalohematoma is a protrusion or bulge in the back of a baby's head which forms soon after birth. At first the bulge (which is the pool of internal blood) will feel soft to the touch. Gradually the pooled blood under the scalp will begin to calcify and the bulge will get harder and denser.

Diagnosis

The appearance of a bulge on your baby’s head may be enough to make a diagnosis, but your doctor may order additional tests before confirming the diagnosis.

 Additional tests that your doctor may order include:

X-ray: Uses ionizing radiation to produce images of the bones and other internal structures. X-rays are painless and quick tests.

CT scan: Uses ionizing radiation to produce cross-sections of the inside of the body. CT scans include images of bones, soft tissue and blood vessels. They are quick and painless tests.

MRI: Uses magnetic waves to product images of tissue and organs inside the body. MRIs are painless, but do require around 45 minutes, which can be distressing for some people.

Ultrasound: Uses sound waves to produce images of organs and internal structures of the body. It is also the device used to view and monitor infants during pregnancy.

Imaging tests will  if there are any other problems, which will allow to confirm cephalohematoma or make another diagnosis.

Complications

Cephalohematomas do increase a baby's risk of:

• jaundice
• anemia
• infections

In rare instances, a newborn may also have a skull fracture that should heal on its own.

Infants with cephalohematoma are also at a heightened risk for developing jaundice, because as the blood cells break down the levels of bilirubin increase. In these instances, and if the bilirubin is excessively high, cephalohematoma treatment may include phototherapy.

Management 

In most instances, your newborn will not need any treatment for cephalohematoma because it goes away without any medical interventions. The bump goes away after several weeks or months. 

NB!!

One should not attempt to aspirate or drain the cephalohematoma. Aspiration is not effective because the blood has clotted. Also, entering the cephalohematoma with a needle increases the risk of infection and abscess formation.

Caput succedaneum

This is the medical term referring to swelling of the scalp during labor and shortly after delivery. Externally, it may look very similar to cephalohematoma; however, this condition is caused prolonged pressure being exerted on the infant’s head during delivery by a dialated cervix or vaginal walls. Use of forceps and vaccum extractors can also cause caput succedaneum.

Epidemiology

The reported prevalence is between 1.8% and 33.6% of all vaginal births, with the most common risk factors being maternal nulliparity and the use of vacuum delivery. Caput succedaneum may be an indicator of prolonged labor. It is rarely associated with intracranial injury.

Management

No treatment is necessary for this condition, and there should be no long-term effects. The swelling should decrease within several days, and the scalp should appear normal within days or weeks. A large or swollen head is a normal symptom of this condition.

Clavicle fracture

The clavicle is the bone that connects the breastplate (sternum) to the shoulder. It is a very solid bone that has a slight S-shape and can be easily seen in many people. It connects to the sternum at a joint with cartilage called the sternoclavicular joint.

Clavicle, also known as collar bone, fractures are most common injury sustained by newborns during birth. A clavicle fracture is a break in the collar bone and occurs as a result of a difficult delivery or trauma at birth.

Epidemiology

The incidence of clavicle fracture in the newborn population ranges from 0.2 to 3.5% with an associated rate of obstetric brachial palsy (OBP) ranging from 4 to 13%.

Causes

The major causes of clavicular fractures are shoulder dystocia deliveries in vertex presentations and extended arms in breech deliveries. It is usually associated with vigorous, forceful manipulation of the arm and shoulder. However, fracture of the clavicle may also occur in infants following normal delivery.

Management

In most cases, clavicle fractures in newborns heal very quickly without any problems. Usually no treatment is required; however, the parent may be instructed to pin the child's sleeve of the affected arm to the front of their clothing to avoid moving the arm while it heals.

Brachial Plexus Palsy

The brachial plexus is a group of nerves around the shoulder. A loss of movement or weakness of the arm may occur if these nerves are damaged. This injury is called neonatal brachial plexus palsy (NBPP).

Which neonates are at risk?

• Breech delivery
• Maternal obesity
• Larger-than-average newborn (such as an infant of a diabetic mother)
• Difficulty delivering the baby's shoulder after the head has already come out (called shoulder dystocia)

How to know if a baby has brachial plexus palsy?

When a newborn has brachial plexus injury they may experience:

• Muscle weakness or paralysis in the affected arm or hand.
• Decreased movement or sensation in the upper extremity.

Diagnosis

1. X-rays.
2. nerve conduction study (NCS) and electromyogram (EMG) to test nerve and muscle function.
3. computed tomography (CT or CAT scan)
4. magnetic resonance imaging (MRI)

Management

Most babies with a brachial plexus injury regain both movement and feeling in the affected arm. In mild cases, this might happen without treatment. Other babies might need daily physical therapy. A physical therapist will show parents exercises to do at home to help their baby get better.

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Carbapenem-resistant enterobacteriaceae

What is Carbapenem-resistant enterobacteriaceae?

Carbapenem-resistant Enterobacteriaceae (CRE) are a type of bacteria. They can cause serious infections that can be hard to treat. CRE got their name from the fact that they are resistant to carbapenems. Carbapenems are an advanced class of antibiotics.

What is the epidemiology of CRE?

The prevalence of CRE, according to some institutions in epidemic area, varies between 24.7% and 29.8%. The rapid and extensive dissemination of CRE demonstrated that we still lacked sufficient and effective measures to reverse or at least control the current situation.

What causes CRE?

CRE are usually spread person to person through contact with infected or colonized people, particularly contact with wounds or stool (poop). This contact can occur via the hands of healthcare workers, or through medical equipment and devices that have not been correctly cleaned.

How to prevent CRE?

The most important way to prevent the spread of CRE and other antibiotic-resistant infections is to practice good hand-washing. Wash your hands often using soap and water or use an alcohol-based hand sanitizer. Check that anyone who is providing your care also washes his or her hands often.

 

Hand washing is the way!!

NB!!

1. CRE are a group of bacteria that are resistant to certain antibiotics.
2. High and sometimes excessive use of antibiotics has played a part in the growth of CRE.
3. People in the hospital or with certain medical conditions and treatments are mainly at risk from CRE.
4. A CRE infection can affect many parts of the body.
5. Your healthcare provider can diagnose a CRE infection with certain tests.
6. There may not be an effective antibiotic to treat your CRE infection. Your healthcare team can give you supportive care to help you recover.

Symptoms

Symptoms of a CRE infection vary. They may differ with the type of the bacteria involved and the part of the body infected.

One example is Klebsiella pneumoniae . It's a type of bacteria that is often resistant to carbapenems. Infection with these bacteria might lead to symptoms such as:

• Shortness of breath (from pneumonia)
• Pain with urination (from urinary tract infection)
• Pain and swelling of the skin (from skin infection)
• Belly pain (from liver or splenic infection)
• Stiff neck and reduced consciousness (from meningitis infection)
• Fever, chills, and fatigue (from infection in any location)

Infections with other types of CRE may cause different symptoms.

Risk factors of CRE

The main risk factors for CRE acquisition in the United States include exposure to healthcare and exposure to antibiotics. Healthcare-related risk factors include requiring help with most activities of daily living, like toileting and bathing, exposure to an intensive care unit, and mechanical ventilation.

Why are isolation precautions?

Isolation precautions are steps we take to stop infections from spreading from person to person. If you're diagnosed with or exposed to a CRE infection while you're in the hospital: You will be placed in a private room.

The contact precautions are currently recommended to prevent nosocomial transmission of CRE for patients with known or suspected infections or at an increased risk of infection with CRE.

How to diagnose CRE?

Normally is diagnosed by blood tests called blood cultures. These blood cultures contain the bacteria responsible for infection. To demonstrate whether the organism is antibiotic resistant, a test is done called a drug sensitivity test (modified Hodge test).

It is done by  cleaning  the patient  skin and inserting a thin needle into your vein to draw your blood. The process will be repeated using another vein to get the most accurate results.

In a lab, your blood samples will get mixed with a special material called a culture. It helps bacteria or yeast grow if they are already in your blood.

You may be able to get early results within 24 hours of your blood tests. But you might need to wait 48 to 72 hours to learn what kind of yeast or bacteria is causing your infection. You might need other tests, too.

You may be able to get early results within 24 hours of your blood tests. But you might need to wait 48 to 72 hours to learn what kind of yeast or bacteria is causing your infection. You might need other tests, too.

How to treat CRE?

The increasing prevalence of CRE infections represents a major threat to human health. Effective antibiotics against CRE remain very limited, with polymyxins, tigecycline, fosfomycin, and aminoglycoside being the mainstays of anti-CRE therapy.

Here are some drug combinations.

Antibiotics such as aminoglycosides, polymyxin, tigecycline (Tygacil), fosfomycin (Monurol), and temocillin have been used with some success in the treatment of CRE infections.

CRE are resistant to most drugs. These germs make an enzyme that breaks down antibiotics before they can work. That's why the strongest of those drugs, called carbapenems, may not cure the infection.

Prognosis

Without proper treatment, CRE infections can cause severe complications. If a person gets a CRE bloodstream infection, it can be fatal. CRE can cause sepsis, which reduces blood flow to the organs. A UTI could reach the kidneys and cause a kidney infection if a person does not receive treatment.

Carbapenem-resistant Enterobacteriaceae (CRE) cause approximately 13 100 infections, with an 8% mortality rate in the United States annually.

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Shingles

What is Shingles also known as herpes zoster?

Shingles, also known as herpes zoster, gets its name from both Latin and French words for belt, or girdle, and refers to girdle-like skin eruptions on the trunk. Anyone who's had chicken pox can develop this eruption. The reason is that the same virus that causes chicken pox causes zoster.

Shingles (herpes zoster) is a viral infection that causes an outbreak of a painful rash or blisters on the skin.

A reactivation of the chickenpox virus in the body, causing a painful rash.

Anyone who's had chickenpox may develop shingles. It isn't known what reactivates the virus.

What causes Shingles?

It is caused by the varicella-zoster virus, which is the same virus that causes chickenpox. The rash most often appears as a band of rashes or blisters in one area of the body.

Varicella is caused by the varicella-zoster virus. The infectious particles are cell-free virus particles derived from skin lesions or the respiratory tract. Transmission occurs mainly through respiratory droplets that contain the virus, making the disease highly contagious even before the rash appears.

Herpes zoster, also known as shingles, is caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes varicella. Primary infection with VZV causes varicella. Once the illness resolves, the virus remains latent in the dorsal root ganglia.

Risk factors associated to Shingles.

• Being 50 or over. With age, there is a natural decline in cell-mediated immunity
• Infection from human immunodeficiency virus (HIV)
• A chronic medical condition
• Medication that suppresses the immune system
• Having an organ transplant

How to prevent Shingles?

The most effective prevention against shingles is vaccination. The Shingrix vaccine is currently available and recommended for all healthy adults age 50 and over and the Zostavax vaccine is approved for people who are age 60 and older.

How to manage shingles.

Treatments include pain relief and antiviral medication such as aciclovir or valaciclovir. A chickenpox vaccine in childhood or a shingles vaccine as an adult can minimise the risk of developing shingles.

Important to know!

Several antiviral medicines acyclovir, valacyclovir, and famciclovir are available to treat shingles and shorten the length and severity of the illness. These medicines are most effective if you start taking them as soon as possible after the rash appears.

Best analgesic to use.

Medications like ibuprofen or acetaminophen are often used. More severe cases might call for use of Tylenol with codeine or oxycodone.

Mortality rate.

Shingles causes fewer than 100 deaths annually. Almost all shingles deaths are in elderly or people with compromised immune system.

Chickenpox

A highly contagious viral infection causing an itchy, blister-like rash on the skin.

Chickenpox is highly contagious to those who haven't had the disease or been vaccinated against it.

What causes Chickenpox?

Chickenpox is a highly contagious disease caused by the varicella-zoster virus (VZV). It can cause an itchy, blister-like rash. The rash first appears on the chest, back, and face, and then spreads over the entire body, causing between 250 and 500 itchy blisters.

Interesting I think, chickenpox and shingles are caused by the same virus but the difference being the manifestation.

Symptoms

The itchy blister rash caused by chickenpox infection appears 10 to 21 days after exposure to the virus and usually lasts about five to 10 days.

• Fever.
• Loss of appetite.
• Headache.
• Tiredness and a general feeling of being unwell (malaise)

Let's take some time to differentiate between chickenpox and shingles.

Looking at Shingles the distribution of the blisters, it follows the dermatomes. While on the other side the Chickenpox blisters are global meaning they cover the whole body.

Chickenpox

A highly contagious viral infection causing an itchy, blister-like rash on the skin.

Chickenpox is highly contagious to those who haven't had the disease or been vaccinated against it.

Who is at risk of acquiring chickenpox?

Risk factors which increase the likelihood of contracting chickenpox include, people without a history of chickenpox in the past, individuals who are not immunized against chickenpox, newborns, especially those born prematurely (less than 1 month or born to mothers who never contracted chickenpox prior to pregnancy), immunocompromised individuals, cancer patients and the use of immunosuppressant drugs.

Prevention of Chickenpox

The best way to prevent chickenpox is to get the chickenpox vaccine. Everyone—including children, adolescents, and adults—should get two doses of chickenpox vaccine if they have never had chickenpox or were never vaccinated. Chickenpox vaccine is very safe and effective at preventing the disease.

Management of chickenpox

Treating Chickenpox is similar to Shingles, best treated early than later.

There are antiviral medications licensed for treatment of chickenpox. The medication works best if it is given as early as possible, preferably within the first 24 hours after the rash starts. For more information, see Acyclovir Treatment.

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Diabetic foot

What is dia diabetic foot?

Foot problems are common in people with diabetes. They can happen over time when high blood sugar damages the nerves and blood vessels in the feet. The nerve damage, called diabetic neuropathy, can cause numbness, tingling, pain, or a loss of feeling in your feet.

This is a mi or issue to the majority, but it can lead to severe complications.

Mainly septicemia or worse leading to an amputation.

During my years of study they emphasized that prevention is better than  cure.

What causes diabetic feet?

Long-term high blood sugar can cause a type of nerve damage called diabetic neuropathy. Diabetic neuropathy can occur throughout the body, but most often in the legs and feet. The condition might make you lose feeling in your feet.

Symptoms 

If you have diabetes, having too much glucose in your blood for a long time can cause some serious complications, including foot problems.

How Can Diabetes Affect My Feet?

Diabetes can cause two problems that can affect your feet:

• Diabetic neuropathy. Uncontrolled diabetes can damage your nerves. If you have damaged nerves in your legs and feet, you might not feel heat, cold, or pain there. This lack of feeling is called "sensory diabetic neuropathy." If you do not feel a cut or sore on your foot because of neuropathy, the cut could get worse and become infected. The muscles of your foot may not work properly because nerves to the muscles are damaged. This could cause your foot to not align properly and create too much pressure on one part of your foot.

Peripheral Neuropathy

This type usually affects the feet and legs. Rare cases affect the arms, abdomen, and back.

Symptoms include:

• Tingling
• Numbness (which may become permanent)
• Burning (especially in the evening)
• Pain

Fungal infection of nails

Nails that are infected with a fungus may become discolored (yellowish-brown or opaque), thick, and brittle and may separate from the rest of your nail. In some cases, your nail may crumble. The dark, moist, and warm environment of shoes can help a fungus grow. An injury to your nail can also lead to a fungal infection. Fungal nail infections are hard to treat. Medications applied to the nail are available, but they only help a small number of fungal nail problems. You may need prescription medicine that you take by mouth. Your doctor might also remove the damaged nail.

How many people get amputations as a result of diabetic foot.

In the United States, every year about 73,000 amputations of the lower limb not related to trauma are performed on people with diabetes. 3. Of non-traumatic amputations in the United States, 60% are performed on people with diabetes.

In the United States, every 17 seconds someone is diagnosed with diabetes, and everyday 230 Americans with diabetes will suffer an amputation,” Fakorede wrote. “Throughout the world, it is estimated that every 30 seconds a leg is amputated. And 85% of these amputations were the result of a diabetic foot ulcer.”

How to prevent diabetic foot?

1. Do inspect your feet daily. ...
2. Do wear comfortable shoes. ...
3. Do wash your feet regularly. ...
4. Do use lubricants  or moisturizers  to keep your skin from getting dry or cracking. ...
5. Do cut your nails straight across, and avoid cutting into the corners of the nails.

Management of diabetic foot 

The management of diabetic foot ulcers requires offloading the wound, daily saline or similar dressings to provide a moist wound environment, debridement when necessary, antibiotic therapy with or without surgical intervention if osteomyelitis or soft tissue infection is present, optimal control of blood glucose, and evaluation and correction of peripheral arterial insufficiency. 

To promote ulcer healing in a person with diabetes and a neuropathic plantar ulcer, consider, if nonsurgical offloading therapy is unsuccessful, Achilles tendon lengthening, metatarsal head resection, or joint arthroplasty.

A multidisciplinary approach including preventive strategy, patient and staff education, and multifactorial treatment of foot ulcers has been reported to reduce the amputation rate by more than 50%.link

Common Cold

What is a common cold? 

A common viral infection of the nose and throat.

In contrast to the flu, a common cold can be caused by many different types of viruses. The condition is generally harmless and symptoms usually resolve within two weeks.

What mostly confuses many is telling the difference between common cold and flu, flu will be discussed in details later.

Epidemiology

The average incidence of the common cold is five to seven episodes per year in preschool children, and two to three per year by adulthood. Annual absences from school and work in the United States due to colds caused 26 and 23 million lost days, respectively.

Symptoms

• Runny or stuffy nose.
• Sore throat.
• Cough.
• Congestion.
• Slight body aches or a mild headache.
• Sneezing.
• Low-grade fever.
• Generally feeling unwell.

Usually self-diagnosable

Symptoms include a runny nose, sneezing and congestion. High fever or severe symptoms are reasons to see a doctor, especially in children.

Diagnosis of common cold

Most people with a common cold can be diagnosed by their signs and symptoms. If your doctor suspects that you have a bacterial infection or other condition, he or she may order a chest X-ray or other tests to rule out other causes of your symptoms.

Interesting fact!!

A complete blood count (CBC) in a person who is sick with an acute infection often shows elevated neutrophils and low lymphocytes, so I would recommend evaluation during a time when you are well, if possible.

Prevention of common cold

You can help reduce your risk of getting a cold: wash your hands often, avoid close contact with sick people, and don't touch your face with unwashed hands. Common colds are the main reason that children miss school and adults miss work. Each year in the United States, there are millions of cases of the common cold.

Management of common cold

Its mostly symptomatic, well I simple words you manage the symptoms.

To make yourself as comfortable as possible when you have a cold, try some of these suggestions:

• Drink plenty of fluids. Water, juice, clear broth or warm lemon water are good choices. ...
• Sip warm liquids. ...
• Rest. ...
• Adjust your room's temperature and humidity. ...
• Soothe a sore throat. ...
• Try saline nasal drops or sprays.

What is FLU?

A common viral infection that can be deadly, especially in high-risk groups.

The flu attacks the lungs, nose and throat. Young children, older adults, pregnant women and people with chronic disease or weak immune systems are at high risk.

Flu symptoms

Influenza (flu) can cause mild to severe illness, and at times can lead to death. Flu is different from a cold. Flu usually comes on suddenly. People who have flu often feel some or all of these symptoms:

• fever or feeling feverish/chills
• cough
• sore throat
• runny or stuffy nose
• muscle or body aches
• headaches
• fatigue (tiredness)
• some people may have vomiting and diarrhea, though this is more common in children than adults.

NB!

It’s important to note that not everyone with flu will have a fever.

Diagnosing flu 

This are some methods you can use to diagnose flu.

• The Lab-in-a-Tube (Liat) influenza A/B assay, which can detect and differentiate influenza A and B strains in healthcare settings within 20 minutes. The assay was originally developed by Massachusetts-based IQuum; Roche acquired the company in 2014.
• The FilmArray diagnostic system, developed by BioFire Diagnostics, LLC, based in Utah, which uses PCR to detect viruses, bacteria, yeast and parasites in roughly an hour. Specifically, the FilmArray respiratory panel, which is designed for use in hospital laboratories and point-of-care settings, can differentiate flu strains.
• The Xpert Flu A/B diagnostic, developed by Sunnyvale, Calif.-based Cepheid, which can rapidly detect and differentiate flu type A from flu type B and identify the 2009 H1N1 flu strain.
• The QuickVue Influenza Test, developed by San Diego-based Quidel, which detects and differentiates flu type A and flu type B based on nasal or nasopharyngeal swabs or nasal specimens.

Management of flu

Flu is also treated symptomatically. Usually, you'll need nothing more than rest and plenty of fluids to treat the flu. But if you have a severe infection or are at higher risk of complications, your doctor may prescribe an antiviral drug to treat the flu. These drugs can include oseltamivir (Tamiflu), zanamivir (Relenza), peramivir (Rapivab) or baloxavir (Xofluza). These drugs may shorten your illness by a day or so and help prevent serious complications.

Oseltamivir is an oral medication. Zanamivir is inhaled through a device similar to an asthma inhaler and shouldn't be used by anyone with certain chronic respiratory problems, such as asthma and lung disease.

Antiviral medication side effects may include nausea and vomiting. These side effects may be lessened if the drug is taken with food.

Most circulating strains of influenza have become resistant to amantadine and rimantadine (Flumadine), which are older antiviral drugs that are no longer recommended.

Measure to take at home

If you do come down with the flu, these measures may help ease your symptoms:

• Drink plenty of liquids. Choose water, juice and warm soups to prevent dehydration.
• Rest. Get more sleep to help your immune system fight infection. You may need to change your activity level, depending on your symptoms.
• Consider pain relievers. Use an over-the-counter pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others), to combat the achiness associated with influenza. Children and teens recovering from flu-like symptoms should never take aspirin because of the risk of Reye's syndrome, a rare but potentially fatal condition.

How to prevent the spread of flu

To help control the spread of influenza in your community, stay home and keep sick children home until the fever has been gone for 24 hours. Avoid being around other people until you're feeling better, unless you're getting medical care. If you do need to leave your home and get medical care, wear a face mask. Wash your hands often.

Prognosis of flu

Most people who get flu will recover in a few days to less than two weeks, but some people will develop complications (such as pneumonia) as a result of flu, some of which can be life-threatening and result in death.

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