Wednesday, April 25, 2012

Travel medicine - Dominicain Republic: Possible cholera outbreak

SANTO DOMINGO, Dominican Republic (AP), update April 23, 2012

Health officials are investigating what could be a new cholera outbreak in the northern Dominican Republic, where one woman died and more than 200 people have sought medical attention, Health Minister Bautista Rojas said lastThursday.
He cautioned that only six of the more than 200 cases have been confirmed as cholera, including that of a 64-year-old woman who died on Wednesday. The remaining patients exhibit cholera symptoms but are awaiting confirmation through lab tests, he said.
The outbreak occurred in the northern town of Tamboril, where heavy rains damaged water and sewer pipes earlier this month.
Bautista said the outbreak is under control, and government officials said they are disinfecting potable water with the maximum amount of chlorine allowed.
The first cholera outbreak in the Dominican Republic occurred in late 2010 with more than 22,500 cases and 163 deaths reported. The number of cases had been dwindling since August 2011.
The neighboring country of Haiti, where the outbreak originated, is still struggling with cholera, which has killed more than 7,000 people and sickened 530,000 more, according to Haitian health officials.

My View : While Cholera vaccine is now available easily in India in the form of oral drops (two doses at a gap of 15 days) for children above 1 year age and adults, it is to be recommended for travelers either to these central american countries, or possibly to visitors to West bengal, Orissa and Bangladesh, where cholera still remains a major health problem. Closer to home (in Chandigarh) special situations with large gatherings of people, like the Kumbh mela may be another appropriate indication of the same.

Monday, April 23, 2012

What to do when your favourite stock crashes?

Investing is all about doing your homework. You read up on a company, study its fundamentals, understand its business and then buy it when valuations are right. And if you have done your homework right, you can sit back and watch the show. In the long run you are bound to make money and earn handsome returns. But what happens when this favourite stock of yours comes crashing down? Well, most investors tend to skip a heartbeat when that happens. And the big question that haunts them is what should I do now? Should I sell the stock and book losses? Or should I hold on to it like I had initially planned? 

The answers to these questions are to go back to your homework. The key is to study what went wrong. The sudden crash can be a result of either of the two things. The first is a one-off event like quarterly numbers, rupee movement, etc. These are not permanent events but the stock markets tend to react sharply to them. If the event is not permanent, then the impact on the stock should not be permanent either. Hence no cause for worry. Your long term view should remain. 

The second is a more serious problem. And that is a change in the fundamentals of the company. This could be the result of change in company policies, acquisitions or business sell offs, change in government regulations, etc. In all, events that are more permanent in nature and hence impacting the overall fundamentals of the company. If the fundamentals of the company have changed and are no longer in line with your previous estimates, then there is only one course of action that remains. And that is to get rid of the stock and book losses. 

So the bottom line still remains the same. Whether there is a crash or a boom in the stock price, always go back to the basics. If the fundamental strength of the company is intact, such crashes should be viewed as an opportunity to reduce your cost of purchase, i.e., buy more of the stock. If fundamentals are no longer the same, then it is time to get rid of your favourite stock. 


I find the above mentioned Equity Master free newsletter a great source for unbiased information about the Indian Financial markets, especially since being a doctor, I do not have a detailed financial background.

Wednesday, April 4, 2012

Travel Medicine Update - WHO / Meningococcal Disease: situation in the African Meningitis Belt

World Health Organization: Global Alert and Response (GAR): March 2012
From 1 January to 11 March (epidemiologic week 10), outbreaks of meningococcal disease has been reported in 15 districts in Benin, Burkina Faso, Chad, Côte d'Ivoire and Ghana.
These outbreaks have been detected as part of the enhanced surveillance in the African Meningitis Belt conducted in 14 countries where a total of 6 685 suspected meningitis cases including 639 deaths have been reported.
WHO continues to monitor the epidemiological situation closely, in collaboration with partners and Ministry of Health in the affected countries.
Travelers are reminded of the importance of keeping their vaccination status up to date and to follow WHO travel advice.

WHO emphasizes that individuals planning to travel to countries in the African Meningitis Belt obtain vaccine to protect against the four serogroups responsible for the epidemic disease (tetravalent vaccine ACYW135).

Monday, April 2, 2012

Travel health - Long Distance Traveling & Deep Vein Thrombosis

CDC / Long-distance travelers : Deep Vein Thrombosis and Pulmonary Embolism
Center for Disease Control and Prevention: Announcement: March 29, 2012

Some long-distance travelers are at risk for deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT occurs when a blood clot forms in a large vein. Part of a clot may break off and travel to the lungs, causing a PE, which can be fatal
Protect yourself by knowing your risk and taking steps to prevent DVT.

Almost anyone can have DVT. People traveling for extended periods of time may be at increased risk for DVT because they have limited movement. The increased risk is usually associated with air travel, but DVT can also form during travel by bus, train, or car.
Most people who develop travel-associated DVT have additional risk factors, including:
  • A previous blood clot
  • Known clotting disorder
  • Recent surgery or injury
  • Use of estrogen-containing birth control or hormone replacement therapy
  • Older age
  • Obesity
  • Active cancer (or undergoing chemotherapy)
  • Limited mobility
Steps to DVT Prevention
You can take steps to help prevent DVT. For long distance travelers, these steps include
  • Getting up occasionally and walking around.
  • Exercising your calf muscles and stretching your legs while you're sitting. Try these exercises next time you travel:
    • Raising and lowering your heels while keeping your toes on the floor.
    • Raising and lowering your toes while keeping your heels on the floor.
    • Tightening and releasing your leg muscles.
  • Selecting an aisle seat when possible.
For long-distance travelers with additional risk factors for DVT, talk to your doctor about taking extra precautions such as
  • Wearing properly fitted medical compression stockings.
  • Taking medication before departure to prevent DVT.
Symptoms, Diagnosis, and Treatment
It is helpful to know the signs and symptoms in the event that you develop DVT or PE. If you have symptoms of DVT call a doctor right away. If you have symptoms of PE you should seek immediate medical care from a doctor or the emergency department. Early detection and treatment can prevent death or complications.
DVT Symptoms
  • Swelling, pain, or tenderness in the affected limb (usually the leg)
  • Redness and increased warmth of the skin in the affected limb
PE Symptoms
  • Unexplained shortness of breath
  • Faster than normal heartbeat
  • Chest pain
  • Cough (which may be bloody)
  • Lightheadedness or fainting

My Take.....
One of close relatives was a consultant for many Western automotive manufacturers, and he traveled extensively on long hop flights. He had a severe stroke secondary to a DVT and died in Germany. 
Given the increasing number of long distance travelers from India, the risk of this condition cannot be overstated. Keeping your self well hydrated, exercising regularly (just walking will suffice), and using stockings/ medicines (if prescribed) can substantially lower the risk of DVT and embolism in most individuals.