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SYMPTOMS/SIGNS/OBSOLETE/EVERGREEN NEW
DO ‘CHILLS’ WITHOUT FEVER HAVE ANY SIGNIFICANCE?
OP Kapoor
Chills (and not ‘rigors’) often precede a fever by a few hours or a day. Often chills are present along with fever and are seen in malaria, typhoid, flu, pyelonephritis, infective endocarditis, pneumonia, etc.
But, what about chills without fever?
First of all, advise the patient to record the temperature with a thermometer. A patient having chills should also be advised to undergo the usual investigations of pyrexia. If the X-ray Chest shows a shadow, or if the sonography shows an abnormal area of SOL, or the CBC report shows leucocytosis or leucopenia, or if the ESR is elevated (moderately/markedly), further investigations are called for.
These investigations include multiple cultures of blood, urine or other body fluids.
Quite often, I see patients who have recovered from a febrile illness but still continue to experience chills in the convalescence period. Sometimes neurotic, tense or depressed ladies complain of this symptom. In such cases, if the above investigations are normal, there should be no cause for anxiety.
Vice versa, some patients persistently complain of excessive sweating without any rise in temperature for a few days during the convalescence period.
Acknowledgement
I am thankful to Dr. Jehangir Sorabjee for going through the script and sharing his experience.
HIP PROTECTORS REDUCE FRACTURES
A structured intervention programme comprising education and free equipment increases the use of hip protectors, which in turn reduces the number of hip fractures in elderly people. Meyer and colleagues conducted a cluster randomised controlled trial with 942 residents from 49 nursing home clusters. The incidence of hip fractures was reduced by almost 40% in the clusters allocated to structured education and free hip protectors compared with optimised usual care. Hip protectors reduce the impact of falls and hip fractures; their acceptability among patients and clinicians needs to be improved.
BMJ, 2003; 326 : 76.
