FISH &CALCIUM TREATMENT.

Introduction:
calcium is an important ion necessary for normal human cell function&its activity.Mainly
it is required for 1)growth of bones in children.2)electrical conduction in nerves.
3)maintenance of normal blood clotting mechanism.4)to prevent bone fracture in certain developmental disorders of bones(osteogenesis imperfecta) 5)osteoporosis in elderly post menopausal women

calcium treatment in general;
commercially lot of preparation available in pharmacy for the treatment of conditions1-4.for osteoporosis calcium given alone is ineffective,because calcium deposition on the bones depends upon the hormone oestrogen's availability.In postmenopausal women oestrogen is very less or absent in blood therefore calcium given alone will not get deposited in the bone to prevent fracture which is very common when they fall down in bath room causing fracture spine which is very difficult to treat.

what is the solution?
---------------------
What is the best form of calcium supplementation, for such elderly people?
Prophylactic &curative treatment of choice is only to eat small lean fish ,thrice a week without removing the bone which contains calcium. women from age 45 onwards should start taking this fish eating habit as a prophylaxis measure against osteoporosis,as many will sure to get it otherwise.vegetarians suffer more.Small fish-example:sardines,any small lean fish like MATHTHI,
AYIRAI, NETHILI(ALL TAMIL)All cooked of course preferably in a crispy way.Oestrogen supplementation in old women is under debate,as it can potentially cause cancer breast or cancer uterus in those who take oestrogen after 50 should take mammogram test& pappinicolatest

to detect cancer early.So we are between the devil &the deep sea.devil is osteoporosis &deep sea is cancer.To be or not to be has to be decided individually to give or not to give oestrogen.fish eating is naturally available source of calcium,accepted by the body unlike commercial preparations.

FISH &CALCIUM TREATMENT

malaria&dengue in a child-rarest of a rare case .

DR PSELVARAJ.CONSULTANT PEDIATRICIAN,. SRM SPECIALITY HOSPITAL
SRM UNIVERSITY
CHENNAI.
TO
THE EDITOR THE ANTISEPTIC

SIR. I AM SENDING AN ARTICLE FOR YOUR PERUSAL &CONSIDERATION OF
PUBLICATION IN YOUR JOURNAL.
THANKING YOU
DR P SELVARAJ.


MALARIA &DENGUE IN A CHILD.
------------------------------------
INTRODUCTION:WE GET ABOUT 300 CHILDREN PER MONTH WITH HISTORY OF FEVER,RARELY WE GET A POSITIVE SMEAR STUDY FOR MALARIA.THIS CHILD SOUGHT ADMISSION AFTER FAILURE OF ANTIBIOTIC THERAPY,FOR ONE WEEK FOR FEVER FROM A GP.MORE OVER THIS IS SWINE FLU SEASON &PEOPLE ARE SCARED THAT ALL FEVERS COULD BE SWINE FLU FEVER.!

ABSTRACT:A CHILD WAS ADMITTED FOR FEVER OF ONE WEEK DURATION.SHE HAD HEPATOMEGALY LOW PLATELET COUNT LEUCOPENIA,&PLASMODIUM VIVAX MALARIA.SHE MADE AN EVENTFUL RECOVERY WITH ANTIMALARIALS+PLATELET TRANSFUSION.

KEY WORDS:LEUCOPENIA,THROMBOCYTOPENIA,ECHYMOTIC PATCH,DENGUE HAEMORRHAGIC FEVER,IgG IgM ANTIBODIESSWINE FLU.
CASE PRESENTATION:
A 12 YEAR OLD GIRL CHILD WAS ADMITTED FOR FEVER OF ONE WEEK DURATION.SHE LOOKED VERY SICK,AS SHE HAD FREQUENT &SEVERE VOMITING.HER TEMPERATURE WAS 104.F.HAD BLUISH PATCHES ON THE SKIN AROUND ANKLES,REDDISH SPOTS ON THE UPPER ARMS.ECHYMOTIC PATCHES AT 3 SPOTS IN THE UPPER ARMS .HAD
GENERALISED PRURITIS&ALSO LOCALISED IN THE LEGS AT,HEMORRHAGIC
SUB CUTANIOUS SITES.,AS ALSO AT EXTERNAL GENITALIA,MORE NEAR URETHRAL MEATUS.
INVESTIGATIONS:
THE FOLLOWING INVESTIGATIONS WERE DONE:
HB,TBC,DC,ESR,PERIPHERAL SMEAR STUDY ,PLATELET COUNT, BLOOD GROUPING RH TYPING,IgG&IgM ANTIBODIES FOR DENGUE FEVER,URINE C&S FOR 3DAYS.

DIFFERENTIAL DIAGNOSIS:
1)MALARIA:ANY FEVER CAN BE DIAGNOSED AS CLINICAL MALARIA EVEN WITHOUT BLOOD SMEAR STUDY.IN OUR CASE SMEAR WAS POSITIVE FOR VIVAX MALARIA.
2)URINARY TRACT INFECTION:BEING A FEMALE CHILD WITH PRESENTING VOMITING,UTI IS COMMENEST.
3)SWINE FLU FEVER:CHILD DID NOT HAVE ANY RESPIRATORY SIGN OR SYMPTOM
IT COULD BE SWINE FLU UNLESS PROVED BY THROAT SWAB/STOMACH ASPIRATE.
4)CNS INFECTION:THOUGH CONSCIOUSNESS WAS NORMAL,IT COULD HAVE A CNS PATHOLOGY UNLESS RULED OUT BY A CSF EXAM.
5)DENGUE HEMORRHAGIC FEVER:
SHE HAD CLINICAL EVIDENCE OF SUB CUTANEUS HEMORRHAGIC SPOTS,COUPLED WITH LEUCOPENIA &THROMBOCYTOPENIA,GENERALISED &LOCALISED PRURITIS.
LAST BUT NOT LEAST,TOURNIQUET TEST FOR CAPPILLARY FRAGILITY WAS POSITIVE
LAB TEST FOR IgG ANTIBODIES WAS POSITIVE..
THIS IS A COMMON TROPICAL DISEASE LIKE LEPTOSPIROSIS AT CHENNAI.

DIAGNOSIS:

FINAL DIAGNOSIS:

1)PLASMODIUM VIVAX MALARIA
2)DENGUE HEAMORRHAGIC FEVER
3)LUECOPENIA
4)THROMBOCYTOPENIA
5)SUBCUTANEUS HAEMORRHAGE
6)HEPATOMEGALY

TREATMENT:
ANTIMALARIAL TREATMENT AS PER ,W.H.O.RECOMMENDATIONWAS GIVEN WITH LARIAGO+PRIMAQUIN FOR MALARIA.FOUR UNITS OF PLATELET TRANSFUSIONS GIVEN TO CORRECT HAEMATOLOGICAL ABNORMALITIES.
DISCUSSION:
SCREENING TREATMENT OF A FEVER CASE IS NOT A SIMPLE ONE.MANY GENERAL PRACTITIONERS HAVE THE HABIT OF PRESCRIBING AN ANTIBIOTIC,OFTEN EVEN IF THERE IS NO INDICATION. ANY FEVER MAY BE TREATED AS MALARIA AS PER W.H.O.
MANY DO NOT LIKE THIS VIEW.MALARIAL PARASITE'S ABSENCE FROM PERIPHERAL SMEAR,DOES NOT RULE OUT MALARIA.PARASITES OFTEN BECOME VISIBLE ONLY IF THERE IS ENOUGH LOAD OF PARASITES IN THE BLOOD TO A TUNE OF 2500PARASITES PER ML OF BLOOD.SUCH A SITUATION IS VERY COMMON IN TRIBAL AREAS,OR NEAR JUNGLES,OR NEAR WATER RESERVOIRS,WHERE MOSQUITO'S THRIVE IN ABUNDANCE.
CONCLUSION
---------------
A CASE OF MALARIA+DENGUE HEMORRHAGIC FEVER WAS DIAGNOSED IN A CHILD OF 12 YEARS THROUGH BLOOD MICROBIOLOGY/BIOCHEMISTRY&TREATED SUCCESSFULLY.TO OUR KNOWLEDGE THIS MAY BE THE FIRST PEDIATRIC CASE OF MALARIA+DENGUE COMBINED IN THE SAME CASE,EVER REPORTED IN THE WORD MEDICAL LITERATURE.SHE WAS ASYMPTOMATIC AT THE TIME OF DISCHARGE.

REFERENCES:
1)HARRISON .TEXT BOOK OF MEDICINE,9edition1982
2)WALDO NELSON .TEXT BOOK OF PEDIATRICS
3)OM SESSIONS ET AL.DISCOVERY OF INSECT &HUMAN DENGUE VIRUS HOST FACTORS.
NATURE DOI.2009
4)NIAID.EXPERTS SEE DENGUE AS POTENTIAL THREAT TO US PUBLIC HEALTH.
JAN 8 2008.
DENGUE FEVER REMEDY USE OF PAPPAYA LEAVES.
FORUM.INDIANETZONE.COM/8/DENGUE_FEVER_REMEDY.HTM-
5)TOURNIQUET TEST FOR CAPPILLARY FRAGILITY--W.H.O
6)WWW.WELLSPHERE.COM/TEST FOR DENGUE HAEMORRHAGIC FEVER
7)WHO MEDIA CENTER.MEDIA INQUIRIES@WHO.INT
8)WWW.AMBEF.ORG
9)WWWMMU.ORG
10)WWW.DHPE.ORG/INFECT/DENGUE.HTML.
11)EMERGING INFECTIOUS DISEASE HEALTH GENERAL.
WWW.THE FREE LIBRARY.COM/CONCURRENTPLASMODIUM+VIVAX+MALARIA+AND+DENGUE

LABOUR PAIN (FOR PREGANT&NONPREGNANTWOMAN)
INTRODUCTION:THIS IS PROBABLY THE MOST SEVEREST OF ALL PAINS&IS VARIABLE FROM WOMAN TO WOMAN.

OTHER COMPARABLE PAINS:1)SEVERE CONSTIPATION LEADING TO FOECOLITH FORMATION(SMALL STONE LIKE BALLS OF FOECAL MATTER)2)PAIN OF DEFECATION IN HIRSPRUNGS DISEASE(CONGENITAL MEGA COLON) IN EITHER SEX WHERE PERSON PASSES STOOLS ONCE IN 15 DAYS.IT IS A TYPICAL PAIN COMPARABLE TO LABOUR PAINS.3)OTHER PAINS LIKE KIDNEY STONE ,GALLBLADDER STONE,PAINS OF PEPTIC ULCER ETC,ETC,ETC.

ABOUT PAIN IN GENERAL.
THE PERCEPTION OF PAIN ITSELF IS VARIABLE FROM PERSON TO PERSON AS PER THE PSYCHOLOGICAL MAKE -UP,OF THE INDIVIDUAL.IT SHOULD BE UNDERSTOOD THAT HOWEVER PAINFUL THE LABOUR MAY BE IT DOES NOT RESULT IN SHOCK OR DEATH. PROVIDED ALL OTHER CLINICAL PARAMETERS ARE NORMAL OR THERE IS NO OBSTRUCTED LABOUR,LIKE CEPHALO-PELVIC DIS PROPORTION,CORD PROLAPSE,HAND PROLAPSE CORD-AROUND THE NECK,OR COMBINATION OF MORE THAN ONE OF THE ABOVE.ALL THESE CONDITIONS ARE DIAGNOSABLE WELL IN ADVANCE &IS GENERALLY TAKEN UP FOR OTHER MODALITY OF DELIVERY,LIKE CAESAR IAN SECTION.THERE FORE THE PAIN PERCEPTION IS MAINLY AS PER THE 'PSCHE'OF THE INDIVIDUAL.THE WRITTER HAS COME ACROSS TWO EXT REAMS OF EXAMPLES IN HIS LIMIT TED OG PRACTICE.

ONE 18 YR OLD UNMARRIED ANGLO INDIAN LADY WITH ALL ABUSIVE LANGUAGE SCOLDING HER BOY FRIEND(WHO WAS ABSCENT IN THE VICINITY)AT THE HIGHEST PITCH OF HER VOICE,DURING LABOUR PAINS.ANOTHER 25 YR OLD MARRIED LADY WAS ABSOLUTELY SILENT,THOUGH WRITHING IN PAIN&THROUGHOUT TILL THE BABY WAS DELIVERED


NATURE OF LABOUR PAIN: THE ANATOMY &PHYSIOLOGY OF FEMALE GENITAL TRACT IS SUCH THE UPPER PART IS
BULBOUS&LOWER PART NARROW.WHEN UPPER PART CONTRACTS THE LOWER PART DILATES &VICEVERSA.
SOME TIMES UPPER PART ONLY CONTRACTS BUT LOWER PART DOES NOT DILATE&THIS IS THE CAUSE FOR A DIFFICULT LABOUR.THE NERVES RESPONSIBLE FOR PAIN IS IN THE SPINAL CORD&IS SELECTIVELY POSSIBLE TO PARALISE,
THE NERVE BY A SPINAL INJECTION.
FOR ALL FIRST PREGNANCIES,CUTTING THE LOWER PART OF THE GENITAL TRACT UNDER LOCAL ANAESTHESIA IS NORMALLY DONE IN ORDER TO FACILITATE DELIVERY.
THE MAIN REASON WHY A PREGNANT WOMAN IS SCARED IS BECAUSE SHE HAS BEEN CONDITIONED ALREADY BY OTHER EXPERIENCED WOMEN THAT THE PAIN WILL BE SEVERE ENOUGH THAT SHE WILL BE NEARER TO DEATH.THIS IS ONE MAJOR CONTRIBUTING CAUSE FOR A CAESAR IAN SECTION.FIVE DECADES BACK MOST DIFFICULT LABOURS WERE MANAGED BY FORCEPS ONLY..EVEN THIS WRITER HAS COME ACROSS A CASE DURING HIS EARLY YEARS .IT WAS A CASE WHERE !)MEMBRANES RUPTURED OUTSIDE,2)HAND PROLAPSE),3)UMBILICAL CORD PROLAPSE.THIS IS A FITTING CASE FOR CAESAR IAN.AS FACILITIES WERE LIMITTED IT WAS DELIVERED BY FORCEPS SUCCESSFULLY.WITH AN INTERRUPTED CHLOROFORM ANAESTHESIA.BY THE WRITER WITH THE HELP OF THREE NURSES!.
CONCLUSION:LABOUR PAIN IS A SEVERE TYPE OF PAIN,OFTEN WITH FEAR OF DEATH.
WHEN THERE IS NO EFFECTIVE CONTRACTION OR LOW OR NO LOWER SEGMENT DILATATION THE WOMAN IS SUBJECTED TO PERIODIC SPASMODIC PAIN WITHOUT GOOD OUTCOME.HENCE 'PITOCIN DRIP' TO ACCELERATE THE CONTRACTION IS OFTEN SUCCESSFUL.WHEN IT FAILS &IF THERE IS EVIDENCE OF FOETAL DISTRESS, THEN THE CASE IS GENERALLY TAKEN UP FOR CESAREAN&THAT IS ULTIMATE.
TAKE HOME MESSAGE:ALL LABOUR PAINS ARE BEARABLE THOUGH IT IS VERY MUCH AGONISING,PROVIDED THE MIND IS CONDITIONED ALREADY.PRE-DELIVERY CONDITIONING &COUNSELLING ARE MANDATORY.

SWINE FLU-A(H1N1) VIRUS VACCINE FEARS

CHINA &USA ARE SHORTLY BRINGING OUT VACCINE AGAINST SWINE FLU,BASED ON 'ROBUST' SUCCESSFUL REPORT AFTER THEIR BTITISH &AUSTRALIAN TRIALS.THE ICMR CHIEF IS VERY CAUTITIOUS ABOUT NOT TO BRING THAT VACCINE TO INDIA,AS HE IS OF OPENION THAT THE VACCINE SHOULD BE MANUFATURED FROM THE VIRUS THAT IS CIRCULATING AMONG INDIAN POPULATION ALONE SHOULD BE CULTURED &USED FOR VACCINE MANUFACTURE.THOUGH THE SIDE EFFECTS LIKELY TO BE THE LEAST ANY THING CAN HAPPEN IN MEDICINE&WE SHOULD OBSERVE VERY CAREFULLY WITH MASTERLY EXPECTANCY ABOUT WHAT IS HAPPENING IN THE REST OF THE WORLD,WHEN A NEW DRUG IS INTRODUSED .PREGNANT WOMEN SHOULD BE GIVEN FIRST PRIORITY FOR VACCINATION ACCORDING TO AMERICAN ACADEMY OF PEDIATRICS.WE SHOULD BE DOUBLY CAREFUL BEFORE SUCH VENTURE AS WE DONT WANT TO SEE ANOTHER THALIDOMIDE -LIKE-TRAGEDY,TO OCCUR IN ANY PART OF THE WORLD.EVEN IF DECIDED TO VACCINATE PREGNANT WOMEN LET US NOT TRY DURING THE FIRST TRIMESTER.THE VIRUS ITSELF CAN CAUSE DAMAGE TO DEVELOPING EMBRIYO.BUT THE VACCINE CAUSING SUCH DAMAGE IS UNACCEPTABLE.

ASPHYXIA NEONATORUM

ASPHYXIA NEONATORUM
A SHORT CUT METHOD TO REDUCE MORTALITY & MORBIDITY.A NEW CONCEPTUAL THOUGHT PRACTICED BY THE AUTHOR FOR THE LAST 20 YEARS.

IF A NEONATE FAILS TO CRY LOUDLY WITHIN 5 MINUTES OF DELIVERY IT NEEDS TO BE RESUSCITATED AGGRESSIVELY.
FOLLOWING STEPS PREFERRED.

1)SUCTION AT LARYNGEAL OPENING.AMNIOTIC FLUID/MECONIUM/VERNICS CASSEOSA ASPIRATION
2)VIGOROUS SQUEEZING OF CHEST WITH THUMB & MIDDLE FINGER AT AXILLAE.
3)SODABICARB 7.5 %+DEXTROSE 10% .5+5=10 ML GIVEN INTRA UMBILLICALLY,THROUGH BUTTERFLY NEEDLE N0 24.
4)WAIT FOR 2-3 MINUTES.OBSERVE THE RESPONSE.TILL ACIDOSIS &HYPOGLYCAEMIA CORRECTION.
IF CRY IS NOT SATISFACTORY-REPEAT DRUGS ONE MORE TIME.
5)DO NT WASTE TIME BY GIVING OXYGEN(MAY BE HELPFUL ONLY FOR R D S.)INTUBATION BY AMBU BAG MAY BE WASTE OF TIME FOR VENTILATION SUPPORT.
6)IF STILL NEONATE DOES NOT CRY ,PUMP IN BECLOMETHASNE INHALER ENDOTRACHEALLY BY A SPECIAL METHOD THROUGH AN ADAPTER.YOUR SUCCESS RATE WILL BE 99%.
7)IF STILL BABY DOES NOT CRY, MILD ELECTRICAL STIMULATION IS WORTH ATTEMPTING THAT IS EQUIVALENT TO DEFIBRILLATION.
8)AN AGGRESSIVE NEONATAL RESUSCITATION SHOULD BE ANTICIPATED IN THE FOLLOWING CONDITIONS PRIOR TO DELIVERY SITUATION.

A)MOTHER HAVING HIGH B.P MEDICATIONS/ALCOHOLISM
B)MOTHER ON ANTI DIABETIC ANTI-CONVULSANT DRUGS
C)CORD AROUND THE NECK
D)MOTHER HAVING SPINAL SHOCK DUE TO DRUGS THROUGH L.P.
E)BIG BABY,TWINS,LBW BABIES,&PRECIOUS BABIES.
F)PROLONGED LABOUR(FOETAL DISTRESS)+/- CLINICAL HYPOGLYCAEMIA.