ADHD-UNPUBLISHED CONCEPT

THE POSTULATED CAUSE IS METABOLIC DISORDER,IN A LOCALISED AREA OF THE BRAIN-THE PRE-FRONTAL CORTEX.BUT AT WHAT AGE(IMMEDIATE POSTNATAL?)IS NOT CLEARED BY INVESTIGATERS.ACTUALLY THIS IS A BEHAVIURAL DISORDER &THERE IS A NEURELOGICALLY DISORDERED MECHANISM SPREAD ALL OVER THE BRAIN,A CHILD'S DISORDERED BEHAVIUR IS NOT CONFINED TO ANY ONE CNS AREA DAMAGE..IT INVOLVES VISION HEARING ,MOTOR FUNCTION,SENSORY,CRANIAL NERVE FUNCTIONSWITH COORDINATION.SUCH WIDE SPREAD DISORDER IS POSSIBLE WITH MEASLES,.THIS CAN NOT BE PROOVED BY EEG ALSO.BUT ULTRAMICROSCOPIC CHANGES DUE TO BRAIN ENVIRONEMENTAL INTERFERENCE,BY VIRUS DRUGS ,INTRA,OR EXTRAUTERINE CAUSESCAN VERY WELL PRODUCE ADHD.THEREFORE IT IS POSSIBLE TO PREVENT THIS DISORDERBY IMMUNISATION,&NO MULTIPLE VACCINATION AT SINGLE SITTING,AS IT CAN CAUSE MICROSCOPIC INTRA-CRANIAL HEAMORRHAGES.BETTER NEONATAL RESUSITATIONIS NECESSARY,AS VERY MINIMALAPHYXIA NEONATORUMCAN ALSO CAUSE ADHD.

UNPUBLISHED MEDICAL CONCEPTS

1) YAWNING-A CLINICAL SIGNIFICANCE.
FROM FOETUS TO FATHER,ALL OF US YAWN MANY TIMES DURING OUR LIFE TIME .VARIOUS POSTULATIONS MADE .SOME ARE:1) OXYGEN LACK, 2) CARBONDIOXIDE ACCUMILATION IN THE BLOOD. 3)AN INVOLUNTARY ACT. 4)NEUROCHEMICAL TRANSMITTERS AFFECTING THE BRAIN TISSUE.5)ASSOCIATED WITH SEIZURE DISORDER LIKE EPILEPSY.6)AN EXPRESSION OF BOREDOM DUE TO PSYCHOLOGICAL DECOMPRESSION.7) A WAY TO REGULATE THE TEMPERATURE OF BLOOD CIRCULATING IN THE BRAIN8)EVEN COMPARED TO AN AIR COOLED ENGINE RADIATER AS IF AN YAWN IS ATHERMOREGULATER.

A U T H E R 'S C O N C E P T:

THOUGH THIS IS ALSO A CONCEPT, THIS CAN NOT BE DISMISSED UNLESS DISPROOVED
BY CERTAIN LAB STUDIES, SPECIALLY BACKED BY E.E.G. STUDIES, DURING WAKEFULNESS,DURING SLEEP, DURING YAWNING.FOLLOWING SCIENTIFICALLY PROOVEN FACTS CAN BE CONSIDERED TO UPHOLD THIS CONCEPT.
A) THIS IS A SLEEP RELATED PHYSICAL SIGN.B)A SIGN RELATED TO BRAIN STIMULATION BY VISION,HEARING,OR BOTH.C)A PREMONITARY SIGN PRIOR TO SEISURE DISORDER . IN ALL THE ABOVE,THERE IS DEFINITE CHANGE OF PATTERN OF E.E.G.,SPECIALLY THEETA WEAVES.

REFERENCES AVAILABLE TO THE EFFECT THAT THERE IS A 30% INCREASE IN THE HEART RATE AFTER YAWNING. BUT BEFORE &DURING YAWNING IT IS MOST LIKELY TO BE 30%LESS CONFIRMING,THAT THE ACT OF YAWNING ITSELF, IS NOTHING BUT A NEURALOGICAL MECHANISM THAT ARRESTS CIRCULATION FOR FEW SECONDS THEREBY PROOVING THAT THERE IS AN ELEMENT OF ELECTRICAL DYSRHYTHMIA
WHICH CAUSES YAWNING & IS AKIN TO A SEISURE DISORDER MOST OFTEN FOLLOWED OR PRECEDED BY SLEEP &CAN BE CONFIRME BY 24 HOUR E,E,G. YAWNING ITSELF IS CONSIDERED BY MANY CLINICIANS AS A VARAENT OF AN EPILEPTIC EQUIVALANT.YAWNING AS A PREMONITARY SIGN OF EPILESY IS WELL DOCUMENTED.

,

AIDS-CONTINUED

AIDS-- CONTINUATION ..


103) HIV LIVING ON THE EDGE OF EXTINCTION
BUT FOR ITS SPREAD TO CITIES IN PERFECTION
DISEASE PREVENTION MOST IMPORTANT
'REUTERS'&'NATURES' REPORT PROVES POTENT.


104)AIDS PANDEMIC RESEARCHERS SAY
DUE TO GENETIC SEQUENCE OF HIV-1 GROUP-M ASSAY
MUTATIONS ACCUMULATE IN HIV ORIGIN
FIRST BEGAN SPREADING FROM 1908TO CARRY ON GENE


105)AIDS ANCESTORS 100 YEARS OLD
SPREAD VIA CHIMPANZEE HUMAN BOLD
HIV INFECTED PEOPLE 33 MILLION
HIV-KILLED PEOPLE 25 MILLION


106)ZIDAVUDINE &ACYCLOVIR FIRST
ZIDAVUDIN&INTERFERON ALPHA NEXT
ZIDA& I V IMMUNOGLOBULIN BEST
DRUG COMBINATION ESTABLISHED JUST.


107)MONTHLY IVIG PROLONGED SURVIVAL
ALSO INCREASED INFECTION FREE REVIVAL
PNEUMOCYSTIS CARNI TRIMETHOPRIME TREATED
SULPHA METHOXAZOLE COMBINATION BEST SUITED.


108)HIGH PCP PROPHYLAXIS FOR CHILDREN UNDER SIX
DEPENDING UPON AGE&T4 CELL COUNT DOSE FIXED
NEBULISATION WITH AEOROSOLISED PENTAMIDINE IS ALTERNATIVE
DAPSONE +TMP CONSIDERED SUPERLATIVE

Case Report

Dr. P. Selvaraj

Consultant paediatrician,

S.R.M Speciality Hospital

RAMAPURAM.

Chennai – 89

TUBERCULOUS ACUTE ON CHRONIC LARYNGO TRACHEO BRONCHITIES

1. Abstract:-

A case of upper respiratory infection due to tuberculosis is presented. In children the usual manifestation is cough with ( or ) without fever and loss of appetite. This 12 year old child presented as whooping cough. Clinical, Radiological, Immnunological, findings along with family History, childs previous history, point towards tuberculous etiology.

2. Keywords

Primary complex, Mx Test, pertussoid cough, spasmodic cough, lymph node biopsy deseminated tuberculosis, TB Meningo encephalitis.

3. Introduction

In children primary complex is usually diagnosed by X- ray chest and Mantoux test along with clinical History of fever, cough and loss of appetite. This child presented as whooping cough, which is unusual in 12 year old child. The article aims at finding out etiopathologically, the causative agent with reasonable supportive findings.

4. Case Presentation

A 12 year old female child weighing (25 kg) looking very much with emaciated face and all four extremities. Presenting complaint was severe cough, spasmodic in nature, ending in the vomiting. Child used to get this 10-15 episodes perday. There was no other complaints, (or) positive physical findings during cough episodes except child’s supra sternal space indrawing was very unusually deep.

5. Previous History:-

Child had fever, cough, positive X- ray findings and treatment for primary complex with single drug regimen Rifamycin 3 years.

6. Family History:

Grand mother is having cough with productive sputum for last 10 years.

7. History of present illness:

Child was having cough and fever for 5 years since repeatedly. Diagnosed as primary complex and treated with Rifamycin. Cough subsided after 6 months. But the general condition went on deteriorating and now having pertussoide cough with frequent episodes in the last 6 months.

8. Clinical exam:

Thin looking individual. Throat NAD, Chest NAD, pertussoide cough still present and not amenable for conventional cough remedies. Has spasmodic cough suggestive of laryngo tracheo bronchitis. Chest clinically normal.

9. Investigations:

X- ray chest normal, mantaux test positive more than 25mm, TC – 8,000

DC

P- 42%

L-57%

E-1%

ESR – 1 hour 46mm

10. Discussion:-

Tuberculosis is still rampant in India, so the incidence of primary complex is also not reduced in the past 3 decades. Dr. P.M. udhani of Bombay was one person who has done maximum number of Histo pathological examination of tissues (lymphnodes mainly), from the paediatric patient’s of tuberculosis 4 decades back. He was only one in India who has made tissue pathological diagnosis in peadiatric tuberculosis to a maximum number. Primary complex can not only affect the pulmonary tissue but also lymphoid tissue in tonsils and the respiratory tract including soft palate, Vocal card, larynx, trachea, Bronchi, bronchioles and all regional lymphnodes and wherever there is increased lymphatic flow. Tuberculosis not only affect the respiratory system where it is known as primary complex in children. It also affect all other system in the body in peadiatric age group, most probably the central nervous system and the liver. In the yestear years disseminated tuberculous and tuberculous meningo encephalitis was often diagnosed. Now it is said to have reduced due to the use of B.C G vaccination. In the International scene India, Malaysia, Singapore, are practicing B.C .G Immunisation in the neonatal states.

1. The inability to eradicate tuberculosis in India is due to drug resistance type of organism (INH reistance)

2. B.C.G Vaccine in not prepared from INH resistant strains of AFB.

3. Pulmonary& tuberculosis with cavity, consolidation, atlectasis must be removed surgically & is being practiced only in the Armed forces India- (Lobectamy, segmental resection, plurectomy are all unheard in most Civil hospital practices) Children with laryngeal tuberculosis almost always have cavitary pulmonary diseases. ( Nelson) our case didn’t have cavitary lesion in lung.

Differential diagnosis:-

Any infection ( Virus/ Bacteria), growth, foreign body or any respiratory allergen, that causes branchial hyper reactivity (or) mucus membarane irritation anywhere is the larynx, trachea can cause this condition.

Bronchi & bronchioles can produce spasmodic pertussoid cough which may result in complete suffocation demanding emergency tracheostomy.

1. Diphtheria: Though the clinical picture is same in all the above pathological process this infection usually produces a membrane like picture over, Tonsils, cricoid, vocal cords, sometimes with haemorrhagic spots. If larynx is involved, tracheostomy often required.

2. H. Influenza Laryngitis: only throat swab can establish diagnosis

3. Viral: Usually acute in onset, preferably during epidemics with change of voice to brassy cough.

4. Pertussis: Age, history of non immunization & throat swab culture can clinch diagnosis. Typical cough in under 5 year child is often diagnostic.

Causative Viruses: Myxovirus, Para influenza

Type I: Measles Virus

Bacterial Agent: Strepto, Staphylo, H Influenza, Tubercle bacillus, : Except AFB all others generally produce acute symptoms. AFB can produce laryngo tracheal stenosis, causing repiratory stridar is a chronic disease with acute exacerbation now & then till disease is cured. When there is a scar in the trachea due to late treatment, symptoms may persist till surgical intervention which may cause further worsening.

Diagnosis:-

Following are positive findings towards diagnosis of this case.

1. Family History (grand mother) suffering from chronic pulmonary disease with productive cough even today since 10 years

2. Presently symptomatic with whooping cough like episode ending in vomiting

3. Clinically looks emaciated

4. Child’s chest X- ray & (primary complex – segmental collapse) taken 5 yrs back& treatment with Rifamycin for 3 yrs only with Rifamycin on & off is insufficient.

5. Mantaux test positive > 25mm now.

Case 2

50 yr old lady. In highly affluent society has cough on and off- 10 yrs, with more severity with expectorations – 5 yrs having spasmodic cough like whooping cough ending in vomiting after a repetitive succession of short coughs. Since – 1 month, not relieved by conventional therapy including steroids seen by well qualified super specialists. She was never investigated O/E Throat NAD looks healthy. Chest minimal wheeze x-ray chest : a) Rt interlobar effusion b) increased translucensy upper zones . c) completely opaque at lower zones sputum for AFB, Concentration method: AFB – positive 6n questioning father has PT being treated.

She was advised 1) inj SM – 45 2) ethambutol 600mg x OD 3. Rcin 600 x OD

The pertussoid cough is under control after 15 inj of SM + R cin + ET + Liv52

Discussion: Formerly all cases of haemoptysis were labelled as PT. Many inclined to see pertussoid cough as LTB of viral etiology & kock’s etiology often went unnoticed & unrecognized caseation is not noticed in our two cases. The author has not seen pertussoid cough in many cases of pulmonary caseation in military Hospital Aundh – Poona ( now military cardio – Thoracic center Golibar maiden Poona). Perhaps in the years to come, Acute on chronic LTB may be the order of the day for chronic Tuberculosis of Respiratory tract.

Treatment:

Being treated with following regimen

Inj. Streptomycin + Rifamycin + ethambutal + Pyrazinamide

↓

(45 Injection)

Prognosis: Child is almost

50%Asymptomatic after 2 weeks therapy

Conclusion

Two cases of Acute on chronic laryngo tracheo bronchitis diagnosed based on family history presenting symptom & supportive radiographic findings. This is an unusual presentation of TB as LTB

Summary

Two cases of Tuberculosis or respiratory system presenting as LTB reported. The unusual findings in pertussoid cough in both cases. But for this they may not have met the doctor, who must be highly kock’s Conscious. In the child, positive mantoax, old X-ray & family history of TB were enough. In the adult X-ray, sputum & family history of TB were positive & enough to clinch the diagnosis. It is this authors personal experience that Inj. Streptomycin should be added to all cases of TB including primary complex if we don’t want future complications. The lesson learnt from these two cases in cough suppressants can work only upto certain limits. When the roof cause is not eradicated, cough will continue & take a different “avatar” – the pertussoid cough demanding for efficacious treatment.

References:

1. Disease of the ear, nose throat:

Fourth editon, them ballentyne & Jhon Groves Bufferworths

2. Short practice of otolaryngology – 3^rd edition by prof KK Ramaligam et al ( page 276)
3. Waldo E Nelson 14^th edition 1992

Tips for practicing pediatricians

1)Be calm in a situation with a calamity.
2)patiently listen to parents version of ailment.
3)Do not jump into conclusions.
4)Take time to think.If required refer book quick..Give assurance that it can be cured
5) Also forget not to mention that it is God who makes final decision.
6)Tell your job is to "give medicine &bandage to the injury.It is God who heals the wound"
7)Some young kids may in an uncomfortable situation &end up in vomiting.
console the parents.SAY THIS MAY HABITUALLY RECUR.&NOT A CONCERN FOR WORRY.
8)In a sturdy 5 year old ,in an uncooperative child,venflon fixing may be extremely difficult..Try butter fly needle to give dose of diazapam ,i.v.to sedate,or wrap the child with a blanket to immobilise the lower extremities.Venesection may also be considered in a critical case like scorpion sting with peripheral circulatory failure.
There are many more tips.If required can consult me-mobile:9841354335.

PEDIATRIC-OPHTHALMOLOGY

PEDIATRIC – OPTHALMOLOGY

EYE SIGNS IN PEDIATRICS

DR. P.SELVARAJ MD. DCH.,
CONSULTANT PEDIATRITIAN
SRM GENERAL HOSPITAL
RAMAPURAM
CHENNAI – 600089 TAMILNADU

ABSTRACT:

In a busy general practioner’s office practice, inspection of eye can be often missed, unless the patient’s complaints point towards eyes. 19 clinical conditions can be diagnosed by inspection of eyes alone if one includes eyes also in the cursery exam. All conditions discussed briefly.

KEY WORD:

· Bitots Spots
· Keratomalasia
· Film star Eyelashes
· Cretinism
· Leukocoria
· Down’s syndrome
· Cataract
· Kayser – Fleischer ring
· Phlectan
· Hydrocephalus
· Naso lacrimal duct obstruction
Aim:
To focus important ‘Eye Signs’ on naked eye examination by inspection alone. Commonest conditions met in the day to day practice while dealing with the children is emphasized. Only external & surface manifestations on the eyeballs are considered. Internal, retinal, optic disc manifestations & ocular syndrome manifestations are not aimed at. It is hoped that this article may be found also useful for a paediatric post graduate/ undergraduate student both for exam point of view & practical usability.

Introduction:

“Eyes don’t see what the mind doesn’t. Therefore it is important that a clinician remembers to look into eyes of children whenever and wherever necessary as a routine examination. Many important diagnosis can be missed if eyes are not looked into. Eye is only a small part of the body reflecting great pathological – events taking place inside body as a whole sometimes very early and sometimes late. Though it is late its significance may be great. (Eye is said to be the window of the brain. This is mainly true with regard to fundus specially during seizure episodes to assess evidence of raised intra- cranial tension where there is a blurred disc margin on fundus examination by opthalmoscope.)

1.Clinical Conditions:

Nineteen important clinical signs pertaining to various clinical –Pathological states are discussed, in brief. Their significance is not only helpful for diagnosis and treatment, but can also alert a physician a possible and impending risky situations likely to be met by the practicing physician during busy hours leading to medico- legal implications.

Vitamin A deficiency – due to nutritional deficiency. The conjunctive of sclera are dull / brownish / silvery scales / plaques/ loose conjuctive with fissues / folds / furrows / Bitots spots / corneal ulceration with different colours and opacification / wrinkling / cloudiness of cornea ( Keratomalacia) & melting of cornea

Film Star Eye lashes:

Dense abnormally long & curved eye lashes on both upper & lower eye lids. Usually seen as a Vit A difficiency as an associated sign along with other signs of malnutrition with or without evidence of primary complex clinically or radiologically. In a well nourished child such a sign may be due to hyper vitaminosis A

Keratomalacia in AGE

Acute onset of keratitis leading to ulcer cornea and eventual blindness observed in most of the diarrhoeal states. During a diarrohoeal episode, inflammed intestinal mucosa can not absorb Vit A. If there is an associated lack of Vitamin A storage in liver, it leads to a sudden lowering of circulating serum vitamin A level which in turn predisposes to development of keratitis. Hence the convenient dictum in all diarrhoeal cases is to give vitamin A 7500 μg as a single stat dose IM Xeropthalmia is a permanent corneal lesion and can not be cured medically though corneal transplantation is the final answer. Medical treatment with injection Vitamin A 7500 μg daily once till healing takes place is recommended.

Exopthalmose:

Sign of hyper thyroidism when the eye is made to look downwards the upper eye lid lags behind. Impairment of convergence and retraction of upper eyelid and in frequent blinking may be present.

Confirm diagnosis by other signs & symptoms as in adults. Blood T3 T4 raised TSH suppressed.

Congenital hyperthyroidism

(Neonatal hyper thyroidism)
Eyes are widely opened and appear exophthalmic all other equivalent signs & symptoms of adults present. Associated jaundice plus or minus
T4 level markedly elevated
Can be due to maternal diseases

Cretinism ( genitically determined)

Narrow palpabral fissure. Very small portion of cornea seen. Confirm with associated signs & symptoms like a. prolongation of neonatal physiological jaundice b. no social smile c. No head control at age 6 months d. lack of alert appearance e. female sex preponderance f. Lithargic state g. Low T3 , T4 & high TSH

Difficult to describe in words. Has to be appreciated by photo or actual looks by visualization

The eye signs & facies are abnormal and is kept in exams for spotter – diagnosis

Treatment: Thyroxine – life long – mental retardation preventable

Diminished Visual acuity

Infant or young child, having poor Visual attention, inability to fixate on an object or reduced response to bright light may suggest diminished acuity of vision.
Nystafmus may be a sign of decreased vision.

Leukocoria: (white pupil) or cats’ eye appearance

Sign of unilateral retinoblastma in the age group of 1 -3 yrs. Strabismus occular misallignment is the first sign of ocular malignancy in 25% of cases. Typically diagnosed in the first year of life in the familial & bilateral cases where both pupils will appear white.

Down’s syndrome:

Distance between central points of both cornea will be greater than normal
Epicanthic folds present
Palpabral fissure tilted upwards and laterally & bilaterally (oblique)
Confirmed by
1. Associated flat nasal bridge
2. Single palmar crease
2. Protruding tongue
3. Mal formed ear lobes
4. Mental retardation
5. High arched palate
6. CHD (VSD)
7. Decreased acetabular / iliac angles (X- ray pelvis)
8. Trisomy 21 ( chromosomal analysis)

Anaemia ( Pallor):

Routinely inspected to see the inside of lower eye lid for presence of pallor. In a neonate it may be a congenital problem either in the bone marrow or red cell destruction due to various causes notably maternal malaria during pregnancy leading to congenital malaria . In Rh incompatibility the yellow colour seen in a pale background

10. Icterus:

Jaundice in a neonate on D1, D2, D3 could be due to blood group incompatibility specially Rh. It is a sign of Hepatitis and Hepato- biliary disease. Currently Leptospirosis and hepatitis A are predominent causes ( most children immunized with Hep-B Vaccine) still blood test for HBs – AG has to be done to rule out ‘Hep B’ or ‘Non- B’ jaundice on D3 and after in a neonate especially in a premature baby is often due to physiological jaundice

11. Phlectanular kerato conjunctivitis:

One or two isolated blood vessels running from angle of eye ending and merging in the lateral margin of cornea, usually unilaterally. It is a sign of Tuberculosis and hence requires confirmation by investigations. It is due to allergy to bacterial (AFB) Protein .

12. Measles conjunctivitis:

Like any other conjunctivitis there is florid inflammation of both conjunctivae Eyes & lower eye lids are deeply inflamed. Associated oral inflammation signs plus fever after D3 confirms. Often there is continuous cough day & night . Maculo – popular rash all over the body is pathagnamonic & diagnostic

13. Madras Eye/ Bombay Eye/ Acco

Purulent conjunctivitis of sudden onset. Often there is widespread diseases in the community as an epidemic. Prior to actual conjunctivitis, puritus, intense over both eyes are significant , conjunctivitis within 24 hrs of pruritis is important. Profusely purulant conjunctivitis within 24 hrs of birth may be due to Gonococcal infection. When conjunctivitis occurs sporadically with closure of eyelids due to purulent material the cause is bacterial often. Antibacterial eye drops recommended for both.

14. Naso Lacrimal duct obstruction

Usually seen in Neonates or young infants.Purulent secretions formed in either eye or both eyes at medial aspect. Gentle rubbing on the surface marking of Naso lacrimal duct 25 times x 2-3 times daily for 1-2 weeks with eyedrops improves condition. Usually reported to doctor after 1-2 weeks of eye drops alone not improving situation without physiotherapy of facial skin.

15. Dehydration:

Eye balls are sunken. Conjuctiva dry, cornea dry only in severe dehydration. Lacrimation less in a crying child. History of diarrhoea /vomiting confirms along with the other signs of clinical dehydration

15. Cataract : ( often Congenital)

May be unilateral or Bilateral may be obviously visible or by ophthalmic microscope usually due to congenital Rubella as a sole finding or with after associated findings like microcephaly , Hepatosplenomegaly CHD/VSD + CNS signs

17. Kayser – Fleis cher ring

Due to deposition of copper in Descemets membrane of over the iris muscle and appears as a fine golden ring around cornea, best appreciated by slit lamp. This is pathagnomonic & diagnostic of wilson’s diseases ( Hepto lenticular degeneration) Any liver disease above age 5 should be thought of and excluded wilson’s disease. Many wilson’s disease in children appear and mimic as an ordinary Hepatitis with jaundice whenever neurological symptoms occur with a liver dysfunction, serum ceruloplasmin level estimated and also urinary copper excretion done.

18. Hydrocephalus:

Eye sign is setting sun appearance on both eyes. Depending upon degree of intra - cranial pressure and CSF obstruction the eye balls are tilted forwards to down wards and the disappearance of significant portion of cornea underneath the lower eyelid is appreciable confirmation by measurement of head circumference 2 to 2-5 cm more than normal is significant. Otherwise serial CT scan brain & serial head circumference measurements are mendatory. This will rule out development of ventriculomegaly and fecilitate early surgical treatment for correction ( Ventriculoperitoneal shunt). This should be strongly suspected in all cases where corrective surgery for meningo – myeerocele’ already done as CSF obstructive signs and symptoms most likely to develope in such infants. Early VP shunt procedure lessens risk of neuronal degeneration of brain tissue.(Brain atrophy)

19. Impending Death

Corneal haziness in a case of very severe dehydration over 15 %, all vital parameter’s come down gradually for a stand still. If cornea is shining it is a sign of life. The lacrimal secretion stops when all after body function stops due to decreasing general blood circulation. It is a sign of end stage of any disease more so and earlier in dehydration .First there is cloudiness, haziness and dusty opacification of transparency of cornea leading to opacification. There is diminished eye ball movements. Puplis are dilating and sluggishly reacting to light gradually unfolding the impending death signs. The HR& RR are gradually coming down. Thus the signs of tissue death noticed earlier in eyes than in any other organs.


Conclusion

The basic rule of clinical medicine is inspection, palpation , percussion and auscultation we skip over occasionally during busy hours this important inspection aspect as we know the diagnosis through other sources many times. Jaundice, anaemia, cataract missed in infants. Like touching anterior fontenalle as routine in a neonatal exam or looking for meconium for anal patency at birth during neonatal resuscitation, looking at eyes routinely can give valuable information in all age groups, more so in pediatrics. One may not make exact diagnosis on inspection. But it will be helpful far further investigation & confirmation. Eye is not only the window of the brain but also the window of the practicing physicians mind. It is the physician’s choice to keep the window closed or open however.

References

Test book of pediatrics: Waldoo Nelson 14th edition 1992
Text book of principles of internal medicine by Harrisons 8th edition 1977
American Academy of ophthalmology 1999- 2000 ( Peadiatric ophthalmology)

AIDS IN POETRY.

INTRODUCTION

1. This is a virus human DISEASE.
Kills numerous at EASE
Post pubertal entering into ‘depth’ AFFECTED.
All extra-maraital / personal intimacy INFECTED

HISTORY

2. History of HIV infection is amazingly CHILLING
Positive sero conversion discovered THIRILING
From a blood sample of the year 1947
So the age of the culprit virus is at least years 57.

3. First noticed from immuno-compormised African HOMOS
Undergoing Chemotherapy at HOMES.
Pneumocystis corni and KAPOSI-SARCOMA.
Found together as flower and AROMA

4. HIV discovery established IN 1984.
In the age group of 14 TO 44 WITH SYMPTOMS FOUR.
Kaposi-sarcoma, T-cell reduction in DEPTH.
Opportunistic infection and ultimate DEATH.

5. What does HIV mean In ANALOGY?
H stands for Human in ANTHRAPOLOGY
I means Immune deficiency in MICROBIOLOGY.
V for virus in the science VIROLOGY.

6. ‘Acquired’ - contracted through source EXTERNAL.
‘Immune’ - Body’s defence from source INTERNAL
‘Deficiency’ - lack or reduction or ABSENCE.
‘Syndrome’ - group of signs, symptoms PRESENCE.


7. Place of origin of HIV is African CONTINENT.
Spread is via multiple points PERTINENT
Syninges, needles, blood, tatooing PERFUSED & ABUSED
Most important is ‘secret (private) cells’ USED.

8. In congenital protective protein is ABSENT.
In acquired, HIV Killing T-cells is PRESENT.
T-cell is important for Body’s DEFENCE
Its absence causes infection in ABUNDANCE.

9. Organisms invasion is nature’s law is ANOMALY.
Different for different species of ANIMALS ONLY
Organisms have species specificity LIMITED
But when rule broken, devastation is UNLIMITED.

10. What is essence of these two on FINE TUNE.
Poor defence leading to infection OPPORTUNE.
In Congenital it is absence of a GLOBULIN.
In Acquired it is HIV throughout GLOBE-IN

HIV-VIURS TRANSFORMATION

11. This is true in transformation of HIV.
Simian (monkey) immune deficiency virus is SIV.
When SIV enters human, it becomes HIV I.
Killing white cells almost leaving NONE.


12. Monkeys don’t eat MONKEYS.
But chimpanzees hunt for only MONKEYS.
Some humans eat chimpanzee MEAT.
Thus virus transformation COMPLETES.

13. Siv Cpz (chimpanzee Virus) enters HUMANS.
This Zoonosis transforms to HIV ONES.
Another animal is sooty mangabeys in W.AFRICA.
This SIV becomes HIV II entering humans even in NON-AFRICANS

14. When HIV & HTLV contracted through “ILIACS”
Especially through transfusion in HEAMOPHILIACS
Aids may become more possible and FIRM.
Western blot, Immunoassay are tools to CONFORM.

15. HIV colonises at point of ENTRY.
Omnipotent in blood tissues like SENTRY
Placenta IN infected pregnancy is TRANSFORMER.
Identifies embryopathy as INFORMER.

HIV-INCUBATION

16. Perinatal incubation is 6-36 MONTHS.
Foetal virus isolation in pregnancy after 4 MONTHS
Post Transfusion incubation is 2 years in PEDIATRICS.
The same is 5-18 yrs in GERIATRICS.

17. HIV’s transport vehicle is infected MONOCYTE
The destination point is CNS ON SITE
Leading pulmonary macrophages INFECTED.
Pneumocystis carni / interstitial pnueumonia develop UNAFFECTED

MODE OF SPREAD OF HIV

18. Spread of HIV by intimate physical CONTACT.
The ‘exchange’ is via red and white fluid passing INTACT
Essence of Microbiology is presence of BODY CELLS.
Deeper muscles / fluid secretions provide MICROSPOIC CELLS.

19. Hepatitis B virus is dangerously AWFUL.
HIV is Ten times Les POWERFUL
Hep N can enter through needle INJURY
But HIV entry often after ‘muscles’ get MERRY

20. Causative agent is electron MICROSCOPIC
Point of body entry is often MACROSCOPIC
Human desire is via muscular ENDSCOPIC
Virus Lives a distance deeper and PROCTOSCOPIC

21. HIV II is less dangerous than HIV I.
Both coextist in certain death in HIV I.
Uncommon death weast africans HIV II.
But Both Spread by via naturalis is TRUE

22. HIV is in Africa and US PREVALANT
Birth place of I and II are Africa DIVALANT
HIV II is more common in WEST AFRICA.
Only to spread to Brazil, UK & N-AMERICA.

23. ‘X Active’ Men (70%) are like HONEY BEES.
Thus Happens ‘Pollengrain’ TRANSFER.
‘X Active’ Women (30%) ‘X Workers, are LIKE FLOWERS.
‘Samething’ Happens in HIV TRANSFER

24. Haiti & Hawaii Have HIV in ABUNDANCE.
Unchecked Blood Transfusion (5%) another HINDERANCE
Mother to Child Vertical Transmission 5-10% Hence.
Any AIDS Secretions / Body Fluids Spreads HIV SINCE



HIV VIRUS ITS CHARECTERISTICS


25. Killed readily by HEAT.
Otherwise remains alive life long very NEAT.
Though incubation maximum is SIX YEARS.
Progression to Aids faster without ARREARS.


26. Acetone, Ethanol, Beta PROPIOLACTONE.
Inactive HIV virus to ATONE
‘Hot cone ice’ is vibrant for infection ACTIVITY
Yet another modality for spread in CAPTIVITY.

27. All that glitter are not GOLD.
All HIV don’t cause AIDS to be BOLD.
But all AIBS are due top HIV ONLY.
AODS is a Killer disease CERTAINLY.

28. Namakkal and Chennai have HIV HIGHEST.
Even school children are affected MODEST.
Gravity of situation WORSENING
Government is engrossed in pointless PLANNING
29. When HIV enters blood it is infection ONLY.
It by itself is not a disease TRULY.
When virus produces symptoms of DISEASE
It is AIDS’ problem with no SOLACE

30. HIV with symptoms of AIDS.
Always deteriorates with virus RAIDS.
Diagnostic Confirmation is final and LAST.
Lies in the patients when breathings LOSt.


31. HIV differs from other INFECTION
In its multifacted PRESENTATION
Important aspect in new PRODUCTION
Is constant mutogenic strains of REPRODUCTION

32. After HIV hep B was trouble SHOOTER
Outcome of both remain HOTTER.
Luckily hep B vaccine DISCOVERED
But mystery of HIV remain UNCOVERED.

33. An imprtant thing is Respiratory SIGN.
Hand in gloves is AIDS and TB FINE.
Either singularly or with other ILLS.
TB in AIDS is like primary complex in MEASLES.

34. Defence crakes and breaks in MEASLES.
In AIDS it is shattered to PIECES.
TB may affect not essentially only LUNGS.
Other organs are not out of BOUNDS.

35. A Syndrome consists symptom COMPLEX
Not unique to any disease to PERPLEX.
Many diseases have fuatures SIMLARITY.
‘Secret hide outs’ nurtures agents in UNIFORMITY.

36. Symptoms vary from fatigue FEVER
Malaise and night sweats EVER.
Weight loss, pain and PYORRHOEA.
Always omni present is DIARRHOEA.

37. Signs are not UNCOMMON.
Lymphadenopathy and wasting EVEN.
Oral leukoplakia, SPLENOMEGALY,
Perianal herpes and ORGANO MEGALY.

38. Poor growth, failure to THRIVE.
Interstitial pneumania and hepatomegaly ARRIVE.
Systemic / pulmonary signs dominate AMERICA.
Diarrhoea, inanition, wasting predominate AFRICA.

39. Patulous lips and Triangular PHILTRUM.
Box forehead and short nose ANTRUM.
Oblique eyes and long palpabral FISSURE.
Facial signs of pediatric AIDS AT LEISURE

40. `What are the AIDS signs?
Prolonged diarrhoea, fever, vomiting, PAINS.
Problematic coughs, kaposi sarcoma GROWTH.
Conventional treatment failure is TRUTH.

41. TB in AIDS is compared to SNAKES.
Lid of snake box is defence at STAKES.
Once lid of box REMOVED.
The ‘TB snake’ raises its HOOD.

42. Pediatric AIDS....
In HIV case if Tuberculin is POSITIVE.
Star INH prophylaxis with INITIATIVE.
Oral polio for HIV children CONTRA INDICATED.
Inactivated polio vaccine SUBSTITUTED.

43. Hypo / Agamaglobulinaemia is CONGENITAL.
Arresting exposure to infection is URGENT AND VITAL.
Often the modus operundi is same as HIV.
Except for the absence of virus HIV.

44. In both child succombs to opportunistic infection O! MAN.
Where conventional therapy failure is COMMON.
If cause is virus AHT is Treatment of CHOICE.
In ELISA negative case aptimmune globulin
replacement WISE.

45. All 2 years and older symptomatic / ASYMPTAMATIC.
Pnemococal vaccine is given AUTOMATIC.
No contra indication for MMR VACCINE.
Immune globulin considered GENUINE.

46. Prognosis in Pediatric AIDS Treatment
Prognosis is always bad and WORSE.
With complication TIDES.
Overall survival upto ten YEARS.
Worse in infection and encophalopathy with FEARS.

47. AIDS –Prevention should at ROOT CAUSE.
Eating monkeys prohibited as FIRST CAUSE.
Monkeys brain is a DELICACY
In star hotel of singapore honkong as FANCY.

48. Aide itself is ACQUIRED.
Congenitally ‘acquired’ exists when ENQUIRED
Prevention strategy is current RESEARCH.
Pediatic AIDS tops the list in scientists SEARCH.

49. Infected mothers transmit HIV to 30 % CHILDREN.
If there is no treatment for mothers and CHILDREN.
transmission rate falls down to 2 %
When both mother and child are treated 100%

50. AZT given during and 3 months prior DELIVERY
Azt given also for 7 days to the NEONATE.
Additional nevirapine treatment given single DOSE.
For mother and child to achieve purpose at EASE.
51. Last but not least researcher SAY.
To keep the mothers breast milk AWAY.
Virus transmission in breast milk is proven
CONTRA-INDICATION.
Formula Bottle feeding along is final DESTINATION.

52. All immune deficiency states and AGE
prone to Infection at some STAGE
low dose antibiotics is a MUST
To escape from infecting organisms THRUST

53. Sulpha, INH, Metrogyl worth CONSIDERING
Frequently at repeated interval DOSING
Though this may not kill HIV
Life prolongation is definite and HEAVY.

54. Curing aids is out of QUESTION.
Prevention helps n disease reduction BEST IN.
Arresting spread will control DISEASE.
AIDS guarnteed even after decades at EASE.

55. AIDS affect Children INNOCENT.
But mode of virus entry is UNPLEASANT.
Through mother’s milk is SUPERFICIAL.
Through maternal blood transfusion it is.
deep and ESSENTIAL.
AIDS – PATHOGENESIS

56. Children in general have less DEFENCE.
AIDS affected children have poor DEFENCE.
It is like adult mechanism of disease PRODUCTION.
Suffering infection due to defence REDUCTION.


57. In adult it is T-cell REDUCTION.
Leads to embarassing INFECTION.
In Children gamaglobulin DEFICIENCY.
Contribute to infection’s EFFICIENCY.

58. HTLVI is a close relative of HIV I.
Lives in human T-cell Lymphocytes OFTEN.
Children are targets from nursing MOTHER.
Other route per via naturalis blammed TOGETHER.


59. This innocent pediatric infection SPREAD.
Through needles, syringes and blood with SPEED.
While remaining asymptomatic decades with ANAEMIA.
May develop Adult T-cell LEUKAEMIA.

60. Half of all pediatric AIDS POPULATION.
Contributed by black POPULATION.
Main cause is non-use of LATEX OR ‘BRAKES’
25% are due to ‘swimming’ BACK STROKES.

61. ‘Same side’ goal strikers are 50%
Opposite side strikers are LESS PERCENT.
Coagulation disease sufferes from 25%
‘Vat 69 or upside down opposite amount 75%

62. Pediatric AIDS in USA FORMS.
Seventh leading cause of death – 1989
WHO INFORMS.
Male female ratio in USA is 3:1.
Same in Africa is 1:1.



63. Pediatric HIV-3 Million WORLDWIDE.

Surviving Under Conrtesy of WHO AID

50% Die Before AGE FIVE.

Within Age Ten Others are not ALIVE.



64. Mother to child HIV Transmission 90%

Through Placental Blood without Intermission 25%

During Delivery Per Via Naturalis 50%

While Breast Feeding Naturally is 15%.


65. Statistics in India Rapidly RAISING.

1% of States Population AIDS SUFFERING.

10 Million Indians will Have AIDS in 5 Yrs.

By Year 2020 Life Expectancy Reduction to 20 Yrs.


66. Statistics in India Rapidly RAISING.

1% of States Population AIDS SUFFERING.

10 Million Indians will Have AIDS in 5 Yrs.

By Year 2020 Life Expectancy Reduction to 20 Yrs.


67. Spread of AIDS can be arrested SOON.

Specially from ‘XXX workers’ as BOON.

Technology available from SELSON.

For proof of pudding dial 044 – 4217-7784 on


68. Many maniacs switch over to VIAGARA.

Only to die in the great falls of HIV NIGARA.

Some develope genital / oral ulcer CHOLERA AND PELLAGRA.

AIDS is an ugly grave unlike TAJ MAHAL OF AGRA.


69. OF AIDS and Simple HIV Infection TEALLY.

Which is more Dangerous TRULY ?

AIDS is Smoked out CIGRAETTE BUTT.

HIV without AIDS is a Tiger with a COW’S SKIN BUT.


70. AIDS diagnosed first IN 1980.

In two decades it multiplied in PLENTY.

AIDS Spread can be arrested in 2 YEARS.

Virus spread can be retarded and checked for ALL YEARS.


71. Prolonged Breast Feeding increases RISK.

Recent Postnatal (Maternal) infection also BRISK & RISK.

Campared to BM Cholostrum has LESS RISK.

During First 90 Days (age) Doubles INFECTION RISK.


HIV AND BREAST MILK


72. How to stop HIV through milk of MOTHER.

When virus swim in maternal blood HITHER AND THITHER.

Either AZT or equilavalent are required to KILL.

Side effect and expenses may swell the BILL.


73. Can we use mother’s milk FILTERS ?

By internal or external source TILT OVER?

Can Mothers milk extracted and IRRADIATED?

Can milk treatment by drugs / UV rays EXPEDITED ?


74. Less Risk Encountered When BM BOILED HA.

Risk in wet nursing by HIV Negative Women FOILED.

AZT to Mother helps throughout PREGNANCY.

AZT + Nevirapine for Neonate helps without POLGNANCY.


75. What are the mother’s milk ADVANTAGES ?

Most important is Immune globulin APPENDRAGES

Bifidus Factor stops neonatal DIARRHOEA.

Last but not least is ‘maternal bonding in SCENERIA.


76. All three are managable as per AREA.

Hygiene sanitation averts DIARRHOEA.

Cheating techique illusions BONDING.

Gamaglobulin injection solution ASTOUNDING.


AIDS – PREVENTION


77. Prevention should hit at root ROOT CAUSE.

Eating monkeys prohibited as first CAUSE.

Monkey brain is a DELICACY.

In star hotels of signapore honkong as FANCY.


78. Current best prophylaxis is LATEX.

Non – use perpertraters regret LATEST.

“Revolutionary method” is better then BEST.

Available by selsens improvised NEST.


79. In this noval method affected destined to DIE.

But unaffected remain non – ingfected after ‘TIE’.

Needles / Syringes / blood are exempted TRULY.

Beneficial fo ‘professional’ workers GENUINELY.


80. Dead yesterday, unborn TOMORROW.

Why fret about them if today has NO SORROW.

Omar kayam’s philosophy applicable TRUE HERE.

WHO should think laterally for the Present and future NEAR.


HIV – ITS COMPLEXITIES

81. Who will do the job of ‘BELL – CATS’?

Non bailable viral arrest warrant is with BILL GATES.

New selson prophylaxis is best to STOP AIDS.

Serious practical thinking helps scientific SIDES.


82. Cure for AIDS is not today’s need – it is a GREED.

Selsens formula sure to arrest the spread INDEED.

Priority to be given to stop speedy SPREAD.

Selson (044-42178874) knows the sensitive THREAD.


83. Will the house-wives and GENTLE MEN.

Opt for Anti-HIV vaccine IN-COMMON?

All or none law ‘applicable in HIV VACCINATION.

Imagining benefit will be fantacy and FACINATION.




84. Drinking, Smoking, Opium are HIV’s cousin BROTHERS.

All drug addictions are HIV’s younger BROTHERS.

HIV itself is like ‘DADH’s half BROTHER.

But father of all brothers is ‘cyanide’ – HIV’ elder BROTHER.


85. ‘Garibi-hatavo’ said Indira GANDHI.

Means ‘poverty go-away in simple HINDHI.

Now ‘HIV hatavo’ says sonia GANDHI.

Like Small pox Exadication for Man Kind’s SHANTHI.


86. Feelings are Pschyo-Physiological CONFLICTS.

Very difficult to tame ‘TARGETS’.

The ‘urge’ has an eye on the ‘BULLS EYE’.

Better to fortify the garden of Edens’s GAL AND GUY.


87. Mangolians and Africans possess eating SIMILARITIES.

In their taste buds of Tongue as SPECIALITIES.

Hypothalamic center is unique IN BOTH.

Desire for delicacies uniformly complied with salivation FROTH.


88. ALDS or SARS as virus diseases Everyone WHO KNOWS.

Is Prevalant in Peculiar flesh eaters as ZOONOSIS.

AIDS originated from eaters of MONKEYS.

SARS originated from eaters of DOGS AND FROGS.


89. Kings / Monarcs in African COUNTRIES.

Subject even their proposed wives to HIV test BOUNDARIES.

The reason is distressing and ALARMING.

40% African population are positive in HIV NAMING.



90. Global Terrorism is due to POPULATION EXPLOSION.

Death Terrorism is due to AIDS EXPLOSION.

Population reduction in hurricane, Floods and VALCANOS.

AIDS more dangerous than nature’s death CASINOS.


NEW AIDS-PREVENTION STRATEGY


91. Selsen has prophylatic specific STATEGY.

Yet Undisclosed by any scienfic TECHNOLOGY.

Practical application will proove TOO GOOD.

Number of strategy are TWO GOOD.


92. Prophylactic researches are in FULL SWING.

To discover anti HIV vaccine to CLING.

Virus Vaccine Production will be a WASTE.

As no one will use it in HASTE.


93. Immune deficiency is the central PIVOT.

Altering immune system is like a RIVETTE.

Can You Thrust vaccine on EVERY ONE?

What is its use if it has no support on ANY ONE?


94. HIV and small pox are not COMPARABLE.

Small pox spread by air is TOLERABLE.

Hence Small pox eradication was POSSIBLE.

HIV vaccine on everyone is UNACCEPTABLE.
95. In small pox entire global population with sincerity VACCINATED.

Scientists call it as Herd IMUNITY.

If entires population NON-VACCANTED.

HIV vaccine a great loss in IMPUNITY.


96. When any STD is clinical / SERLOGICAL

ELISA For HIV throughts LOGICAL

When secretions / ulcers predominate around PUBIS.

HIV’s presence dominate allriound VISA-VIS.


97. one more Childhood immune deficiency is NON-GENITAL

This is different and CONGENITAL.

Cause is agama globulinaemia

98. Syringes and needles sterilisatio IMPOSSIBLES.
After AIDS and hep B – All became DISPOSABLES.
Most blood banks never tested STD in the RACe.
ELISA for HIV is the order of medico-legal CASE.

99. Best of all idea is very SIMPLE.
Economically viable and lie at DIMPLE.
Practicabilty is alternate POSSIBILITY.
Better than best is BM Bank AVAILABILITY.

ANTI – RETROVIRAL DRUGS – FOR AIDS.

100. Zidovudine has life PROLONGATION.
If cd 4 count is 500 confirms HIV INFECTION.
in symptoms with 200 – 500 CD4 COUNTS.
Only zidavudine will help by ALL COUNTS.

101. If CD is less than 200 + in AIDS
Zidavudine as stat doze aids.
But switch over is NECESSARY.
Often with DDI / DDC as COMPULSORY.

102. Selsen’s formula sure to arrest spread and BREED.
Cure for AIDS is not today’s NEED.
Priority given for stopping SPEEDY SPREAD.
AIDS Exlosion is in near vicinity INDEED.

AIDS

SELSEN'S SECRET FORMULA FOR PREVENTION OF AIDS:


(REF: STANZA NO. 91 & 102)

THESE ARE THE IMPORTANT SENTENCES IN THE BOOKLET.& NECESSARY EXPLANATIONS WILL BE GIVEN IN DETAIL
FOR THOSE WHO SEEK FURTHER INFORMATIONS ON THE SUBJECT.WITH ME BY E-MAIL.(PHONE;9144-23790380,
9144-4217 8874,MOBILE-91-9841354335)THIS IS A SIMPLE TECHNIC FOR PREVENTIONOF AIDS,TEORITICALLY SUCESSFUL 100% & WILL BE COMMERCIALLY ALSO VIABLE.A CONFERENCE OF SEXOLOGISTS, VENERIOLOGIST,EXPERTS ON SEXUAL MEDICINE IF CONDUCTEDWILL HAVE GENERAL AGREMENT REGARDING THE APPLICABILITYOF THIS NEW TECHNOLOGY, NOT THOUGHT OF,OR PUBLISHED ANYWHERE IN THE WORLD MEDICAL LITERATURE.I HAVE WRITTEN TO VARIOUS INTELCTUALS ON THIS ISSUE,INCLUDING DR.ABDUL KALAM PAST PRESIDENT OF INDIA.ALL MY LETTERS WENT TO AIDS CELL FOR HYBERNATION!,EXCEPT ONE WHO WAS A LIEUTINANT GENERAL,OFFICER COMMANDING SOUTHEN COMMAND,INDIA.HE RECOMMENDED THAT THIS MAY BE XEROXED & SUPPLIED TO ALL MEDICAL OFFICERS UNDER HIS COMMAND 5 YRS BACK.THERE WAS NO INTERACTION BETWEN ME &ANY POWER HOLDING AUTHORITY.I ASSURE ANY READER THAT THIS NEW TECHNOLOGY CAN BE PROOVED TO CONTAIN AIDS &PREVENT FURTHER SPREAD IF PRACTICED METICULOUSLY.


SELSEN IS A PARAMEDICS IN A US HOSPITAL IN TEXAS.
(sd) DR.PSELVARAJ.FORMERLY PROFESSOR.
NOW,CONSULTANT PEDIATRITIAN.S R M GENERAL HOSPITAL
RAMAPURAM.CHENNAI.600 089.TAMILNADU.INDIA.

ENGLISH TRANSLATION OF


MR.S.VAIRAMUTHU'S

LETTER OF CONGRATULATIONS:


DEAR DR.PSELVARAJ.CHENNAI.

RECEIVED YOUR LETTER.


GOOD ATTEMPT.


CONGRATULATIONS.


I, CONSIDER YOUR POETRY AS A SERVICE.CONTINUE.



AFFECTIONATELY,

(SD) S VAIRAMUTHU.


---------------------------------------------------------------------------------------------------
PREFACE.


THIS IS NOT A SERIOUS BOOKLET FOR READING.OR IS THIS A TREATISE OR A MEDICAL TEXT BOOK ON AIDS.
IT IS MEANT FOR CASUAL RELAXED READING.BUT IT CONTAINS ALMOST ALL THE BASIC DETAILS OF AIDS.
IT IS PRESUMED THAT YOUNG DOCTORS,MEDICAL STUDENTS GENERAL PRACTITIONERS& ALL THOSE WHO KNEW ENGLISH CAN HAVE WIDE GLIMPSE & A BIRD'S EYE VIEW OF AIDS.THE STYLE OF PRESENTATION IS TOTALLY &UNCOMMONLY DIFFERENT.MANY MEDICAL MATTERS ARE EXPRESSED IN A PARTIALLY HIDDEN MANNER,SO THAT THE READER IS COMPELLED TO STRETCH HIS IMAGINATION TO ARRIVE AT THE CORRECT MEANING.LAST BUT NOT LEAST IT CONTAINS A NEW MESSAGE--TO STOP THE SPREAD OF AIDS &MAINTAINED AS A CAT NOT NOT LET OUT OF THE BAG.SO FOR THIS NEW THOUGHTS HAS NOT BEEN DISCUSSED OR PUBLISHED ANYWHERE IN THE MEDICAL LITERATURE.


WRITTEN IN THE FOLLOWING SUB TITLES.
1)HISTORY2)WHAT IS AIDS IF EXPANDED.3)HIV VIRUS TRANSFORMATION4)HIV INCUBATION.5)MODE OF SPREAD OF HIV.6)HIV VIRUS -ITS CHARACTERS/PROPERTIES.7)AIDS -SIGNS &SYMPTOMS.8)PEDIATRIC -AIDS.9)PROGNOSIS IN PEDIATRIC AIDS.10)AIDS-PATHOGENESIS.11)HIV&BREAST MILK.12)AIDS PREVENTION.13)HIV-ITS COMPLEXITIES.14)NEW AIDS PREVENTION STRATEGY.15)ANTI RETROVIRUS DRUGS FOR AIDS.

AIDS THE SILENT KILLER

entire aids of man's and maid's in english strides to stall HIV raides.

REMOTE CONTROLLED MEDICAL CLINICS OF ARJUN&;ARAN.

INTRODUCTION:-THIS IS A MEDICAL CLINIC WITH ALL SUPER SPECIALITY DOCTORS LOCATED IN CHENNAI TO SERVE THE MEDICAL NEEDS OF NRIS &;ALLIED PERSONS MUCH FASTER THAN THEY CAN GET IN THEIR OWN PLACE&; FOUND TO BE VERY HELPFUL IN ALMOST ALL MEDICAL EMERGENCIES SAFELY &;RELIABLY.ASK OUR CLIENTS &;JOIN.
THIS IS MEANT FOR THOSE WHO DONT HAVE EASY ACCESS TO A WELL QUALIFIED PHYSICIAN IN AN EMERGENCY.EXAMPLE:-A PERSON MAY GET LOOSE WATERY MOTION SEVERAL TIMES AFTER DINNER.THIS IS A SYMPTAMATICALLY CURABLE DISORDER.NO NEED TO GO IN SEARCH OF A DOCTOR AT MIDDLE OF THE NIGHT.USEFUL FOR THOSE WHO LIVE IN 1)INACCESSIBLE AREA 2)LIVE IN REMOTE VILLAGE-LIKE CONDITION WHERE DOCTOR IS AVAILABLE AFTER 30 MILES.3)AT A FAR OFF PLACE FROM WORKING AREA OR RESIDENCE.4)IN A PLACE WHERE PHARMACY IS LOCATED AT A FAR OFF PLACE.5)WHERE MEDICINES CAN NOT BE PROCURED WITHOUT A DOCTOR'S PRESCRIPTION 6)PEOPLE LIVING ABROAD.7)PEOPLE WHO FLY FRQUENTLY8)THOSE WHO DONT HAVE TIME FOR DOCTOR'S APPOINMENT &;WAIT.9)ECONOMICALLY NON-VIABILITY.(MANY DRUGS WITHSAME PHARMACUTICAL FORMULATIONS IN INDIA COSTS UPTO 40 TIMES IN USA) DESIGNED TO MEET THE NEEDS OF NRIS IN ANY COUNTRY &MEDICAL AID REACHES THEM IN MINUTES &SOLUTION OBTAINED FOR PROBLEM IN LESS THAN ONE HOUR

P L A N
--------
A SET OF 10 -20 MEDICINES SENT FOR VARIOUS COMMON DAY -TODAY AIL MENTS.A BOOKLET CONTAINING INDICATIONS &;DOSAGE GIVEN. MEDICINE TAKEN ONLY AFTER CONSULTING OUR DOCTOR TELEPHONICALLY AT EACH EPISODE.A 4 LINE TELEPHONE FECILITY AVAILABLE ALL THE 24 HRS.A WELL QUALIFIED PROFESSOR CADRE -DOCTOR IS AVAILABLE ON SHIFT DUTY.THIS IS WORLD'S FIRST ORGANISATION OF THIS KIND &;IS PURELY SERVICE ORIENTED.

DRUGS FOR THE FOLLOWING AILMENTS WILL BE SENT IN PLAN "A"
1)FEVER2)PAIN.3)CONSTIPATION +/-ANUS TEAR 4)DIARRHOEA /VOMITING.5)ALL KINDS OF COUGH. 6)PEPTIC ULCER(BURNING BEHIND CHEST BONE) 7)EAR /NOSE/ THROAT AILMENT8)KNOWN ASTHMA 9)BURNING WHILE PASSING URINE.10)ITCHING SENSE AT GROIN, GENITALS ,ANYWHERE.

IN PLAN "B" WE HAVE MANY GYNACOLOGICAL/MENSTRUAL SOLUTION INCLUDING EMERGENCY CONTRACEPTION(NEW CONCEPT)&;ALSO SOLUTIONS FOR MANY CHILD HEALTH PROBLEMS&; SENIOR CITIZENS.

COST OF PACKAGE.
---------------
1)ONE CONSIGNMENT OF MEDICINE IS USUALLY SUFFICIENT FOR ONE YEAR.
2)COST OF MEDICINE -AROUND-USD 12/PACKAGE +POSTAGE EXTRA.
3)SERVICE CHARGE USD.250/YEAR(WORKS OUT TO USD20/MONTHLY)
4)ALL E MAIL,TELEPHONE CONSULTATIONS FREE.
5)NUMBER OF CONSULTATIONS UNLIMITED.
6)works out toUSD7/HEAD FOR A SMALL FAMILY OF 3
CLINIC - DIRECTOR--DR P.SELVARAJ.M.D.,D.C.H.,F.R.S.H.,(LONDON)
PROFESSOR OF PEDIATRICS-RETIRED.
E-MAIL ,TELEPHONE CONSULTATIONS FREE.

VACCINES-BIRD"S EYE VIEW/IAP-&AAP

Introduction:These two giant organisations in the world are making the policy decisions on immunisations for children&is formulated by Advisery commitee on immunisation practices on the respective countries.This is a comparative study of observation between Indian academy of pediatrics,&American academy of pediatrics regarding their immunisation policy,meant for elite population & N R I S.For completion sake & for quick reference certain other countries' immunisation are included,as we have lot of NRIS IN THESE COUNTRIES:1)INDIA 2)USA3)AUSTRALIA 4)UK 5) MALAYSIA 6)SINGAPORE.
Immunisation is a global procedure against preventable diseases as per prevalance.World's Eco system is such that mother nature has distributed the organisms in its own way.In the densely populated country like India like every dog has its day,these organisms also had their days &played their part to reduce population explosion.The health measures required to counteract simply sucks the country's finance like leeches.People's co operation is essential in disease eradication.In India people expect all vaccines to be available free,thanks to LION'S &ROTARY CLUBS IN PROVIDING HEPATITIS &POLIO VACCINES RESPECTIVELY.Ignorance is still alive even with educated people. Every parent must feel that they are morally responsible for prevention of disease to their children even if one is poor.Let him beg ,borrow, or ,steal to immunise his child.

I A P IMMUNISATION TIME TABLE:2005--2006.
-------------------------------------------------------

Total doctor's visit-10
diseases covered---10(optional vaccines-3)
Birth
OPV-0
Hep B-1
6 weeks DTPW-I/DTPa-1
OPV-1
HEP B-2
Hib-1
10 weeks DTPW-2/DTPa-2
OPV-2
Hib-2
14 weeks DTPW3/DTPa3
OPV-3
HEP.B-3
Hib-3

9 Months. meascles
15-18 months DTPWB-1/DTPaB-1
OPVB-1
Hib B-1
MMR
2 YEARS Typhoid+

5 years DTPWB-2/DTPaB2

10YEARS Td#/TT
16.YEARS Td#/TT


PREGNANT WEMEN:2 DOSES OF Td#/TT.

Vaccines that can be given after discussion with parents:---

>6 WEEKS----------PNUMOCOCCAL CONJUGATE VACCINE *
>15 months---------Varicella(chicken pox)#.
>18 months---------Hep A +
#<13>13 YRS- 2DOSES.(1-2 MONTHS INTERVAL)

+ 2 doses (6-12 months interval) (hep.A)

*3 primary doses at 6, 10 ,14 weeks followed by booster at 15 months (Pnuemococcal)
New recommendations:2 Doses of MMR.USE of combination vaccines &IPV in private practice.
Observation:one of the countries recomendingBCG.Only country to advice typhoid.No rota virus, or meningococcal vaccine advised.Chiken pox,pneumococcal,&hepatitis A are advised after discussion with parents.T .T FOR PREGNANT women advised .


A A P--JAN 2008. (U S A) AMERICAN ACADEMY OF PEDIATRICS.
--------------------
Hep.B-1--Birth,1mo,2 mo,12-15 mo
Rota virus-1 mo,3 mo,6 mo.
Diph,tetanus, pertusis--2mo,4mo,6mo,15mo.
Hib-2mo,4mo,6mo, 12-15mo
pnuemo--2 mo,4 mo,6 mo,12-15 mo.pnuemo-polisacharide(ppv)--2--6yrs.
Inactivated polio--2 mo,4 mo,12-15mo, 4-6 yrs.
Infuenza- yearly.4-6 yrs for certain high risk group
MMR--12-15 mo, 4-6 yrs
Varicella-12-15mo, 4-6yrs.
Hep A---2 doses.12-15 mo--19-23 mo,
Meningococcus:--recomended for teens &college students.
MCV 4--FOR HIGH RISK group,at 2--6 yrs.
HUMAN PAPPILLOMA VIRUS VACCINE :FOR GIRLS AT AGE 12-13YRS.

IMMUNISATION SHCEDULE --UK.SEP 2006.
------------------------------------------------
3 DAYS.--BCG if TB in family in last 6 months.
Hep.B.if mother is Hbs Ag +ve
2 mo.---DTaP+IPV+Hib+pneumococcal(pcv)
3 mo.---DTaP+IPV+Hib+Meningitis-C
4 MO.--DTaP+IPV+Hib(pediacel)+pneumococcal(prevnar)+meningitis-c(neisvac)

12 mo.--Hib+meningitis-c(menitorix)
13 mo.-MMR+Pnuemococcal
3 -1/2---5 yrs.-dtap+ipv, or,Dtap+ipv(,Repavax)or,Infanrix
MMR(Priorix,or mmr)
13-18yrs.-Td+IPV(TETANUS/DIPHTHERIA/POLIO)
OVER 65&
<65 AT RISK GROUP:-Annual influenza vaccine+one of pnuemococcal.

AUSTRALIAN GOVERNMENT--31 OCT 2007
-----------------------------------------------------
Birth :Hep.B
2 mo :DPT+POLIO+Hib+HepB+pnuemo+rota virus
4 mo. :DPT+POLIO+Hib+Hep .B(Infanrix-Hexa)+Pnuemo(prevnar)+Rota virus(Rotateq)
6 mo :DPT+POLIO(IPV)+Hib+Hep.B+Pnuemococal+Rotavirus.

12mo :MMR+Hib+Hep.B+ Meningococcal-C.
18 mo.VARICELLA.
4 YRS :DPT+POLIO+MMR.
Comments:No,BCG/TYPHOID/H EPATITIS A advised.

M A L A Y S I A 28 FEB 2006
---------------------------------
At birth : B C G

2. mo.---Hep,B+OPV+DPT/DT+Hib

3.mo---Hep.B+opv+DPT/DT+Hib

5.mo.--Hep.B+OPV+DPT/DT+Hib

6.mo.--Meascles.

!2 mo.--MMR

18.mo.--opv+DPT

5-7 yrs.-OPV+DPT+MMR.

12--15yrs--TT+Rubella.
COMMENTS: Hib,/rotavirus/pnuemo/ meningo/Hep A /Influenza/chickenpox are not advised.

SINGAPORE--GOVERNMENT--11-AUG-2007.
-------------------------------------------------
Birth: BCG+Hep.B(FIRST DOSE)

1.mo.--Hep.B (SECOND DOSE)

3.mo.--DPT/DT-- 1st dose.
oral sabin 1st dose

4 .mo-DPT/DT----2nd dose.
oral sabin ---2nd dose.

5.mo.DPT?DT ----3rd dose-----Hep.B. can be combined for patient compliance
oral sabin ----3rd dose.
5-6.mo.--Hep B----3rd dose-if not comb9ned above.

1-2 yrs.----MMR-primary dose.

18. mo.--DPT/DT+ORAL SABIN 1st booster.

6-7yrs--DT+ORAL SABIN-------2nd booster.

11-12 yrs.-DT+ORAL SABIN-----3rd booster.+MMR BOOSTER DOSE.
comments;No Measles/Rubella//Hib/ Pnuemo/meningo/Rota/Influenza/Hep A advised.Using OPV like India.All Other countries using IPV
OBSERVATION & ANALYSIS:
----------------------------------
There is conses of openion for immunising for the following diseases in all the countries.
1) Hepatitis B 2)Polio 3)Diphtheria.4)Tetanus.5)Wooping cough.6)Meascles.7)Mumps.
8)Rubella.
2)Tuberculosis:IAP continues to advice BCG, AS THE DISEASE IS STILL PREVALENT IN INDIA
&also believed to reduce incidence of desseminated TB such as TBM,OR REDUCE THE MORBIDITY IN TBM. Malaysia& singapore continues BCG as INDIA IS NEARBY&there is lot of traveller's movement.Other developed nations stopped BCG as they think the disease has been eradicated, or they believe that TB eradication is better done by other non-vaccine methods like offering better treatment(like surgical removal of the pulmonary liesions wherever
possible)
3)Vaccines for the following disease are advised byIAP,ONLY after discussion with the parents.
a)H.influenza(hib)b)chicken pox.(varilrix for varicella)c)Hepatitis A.d)pnuemococcal vaccine.The reasons are not given.Perhaps it may be due to following causes.a) It is expensive(not available free of cost).b)low incidence of the disease.c)not virulent compared to Hep.B. d)Anaphylaxis &other side effects possible.
4)Following vaccines are advised by AAP ONLY FOR HIGH RISK GROUP.
A) Influenza
B)Hep.A.
C)Meningococcal.
The center for disease control(cdc) in USA from time to time advises adults &kids for influenza shots, whenever there is evidence of a slight epidemic.Recently there was one schoolchild died in USA,&THE AUTHORITIES SAID THAT IT WAS AN ISOLATED CASE,EVEN THOUGH IT IS VACCINE PREVENTABLE DISEASE(T V News.feb 2008 usa)
5)Typhoid is recommended only in india.Does it mean that it has been eradicated world wide?
6)Rota virus vaccine:Advised only by USA& AUSTRALIA.
Mortality is said to be 200-300 per year in USA& all children said to suffer at least once before 5 yrs of age.The occurence of intusseption after vaccine is so negligible that the issue does not seem to merit further discussion.Though in India ROTA VIRUS DIARRHOEA IS PREVALENT.THE MORTALITY RATE HAS COME DOWN.Still the the incidence of diarrhoea &pnumonia are the top two for highest mortality.If pnuemococcal vaccine(prevnar) &rota virus vaccine(rotateq) are used in India,pediatric physicians will have no work!.(Oh! politics,Oh Finance--Thou shall get up?
7)Tetanus Toxoid: in pregnancy(to prevent neonatal tetanus)
Not advised by any country other than India.India can boast almost 100% success in eradicating neonatal tetanus.AAP advises TT/DPT TO ALL CHILDREN.It means tetanus organisms are present in the American soil.Does a pregnant women is immune to tetanus in USA?

8)POLIO:
Polio-immunisation.AAP advises ,inactivated polio vaccines,which is undoubtedly more effective than oral polio.IAP continues to advise ,oral polio only for various socio economic/ political reasons,while fully acknoledging that IPV IS BETTER..AMONG many causes for our inability to eradicate poilo the use of oral polio itself is considered as one cause.Now IAP advises &recomends IPV may be given by private practitioners, if they desire to do so.The key to global polio eradication,lies in India.UP &Madhya pradesh continues to harbour polio virus.Unless the government machinary is fully geared up there like other statesfor polio eradication it can not be expected that global polio eradication is in the near vicinity.UK advises IPV for 13-18 yr age group also.Theoritically &practically it is found to be good in UK.India should emulate this as it is possible for adults to excrete polio virus,in their excreta.These excreta may infect children ,&this is a worthy point to ponder about&if practiced may yield in polio eradication in India or any other country.
AAP;FURTHER RECOMENDS TO ADOLESCENTS as below:This is not recomended by IAP.ALL VACCINES ADMINISTERED IN CHILDHOOD ARE REPEATED ONCE OR TWICE+pappilloma virus vaccine for girls 11-12 yrs ,if not at 13-18 yrs.USA is the only country to recomennds,pappilloma virus vaccine,meningococcal+pnuemococcal also given
DTP+TDaP+HPV=MCV ARE COMPULSARILY GIVEN AT 11-12 YRS All other vaccines either as a catch up immunisation or certain hige risk group (immune difficiency like status)

F I R S T A I D --FOR CHILDREN

Introduction:

Though this is a first aid home treatment for your kids,some of them are suitable to adults also.PLEASE note that this is not a treatment guide for your child's medical problems,BUT ONLY a first aid management at critical times.All drugs named here should be used only for ONE DOSE ONLY& visit doctor at earliest oppertunity.
If a child gets fever at 10 pm one can not wait till morning.If fever is not controlled he may throw a fit.Or suppose,you are urgently moving with your family from one place to another 300 km,your family member gets a vomiting,diarrhoea,acidity,or abdominal pain discomfort,anxiety,what will you do?Or while at home your child swallows few tablets of adults(like anti-diabetic /blood pressure reducing.)what will you do?So it becomes necessary for all mothers to know certain first aid treatment.It is with this hope the following is written& to be practiced only at a critical situation& non availability of doctor for quick help.

FIRST AID TREATMENT AT HOME:
All drugs,can be given as per this schedule.Dose of any adult tablet for children can be given thus.--New born-1/10,6 months-1/6.,1-3 yrs--1/4.,5 yrs-1/2,.10 yrs-1.,
Syrup;New born-5-9 drops.,6 months-1/2tsp.,1-3 yrs--3/4 tsp.,5 yrs--1-2 tsp.
PLEASE remember the above is for single dose only.consult doctor for subsequent dose.

1)FEVER:101.F is significant.Tepid?ice sponging is enough.In very high fever,ice at axilla,groin soles will be required.Doctor will find cause &treat latter.you may use tab/syrup paracetamol
6 months-1/6tab/1/2 tsp.5yrs-1/2 tab..1 tsp.
2)VOMITING:2-3 vomitings significant Ideal treatment-I V Fluids at hospital.or else, tab domperidol,mixed in honey.No feeds for 8 hrs.If vomiting occurs 2 hrs after tab,,go to hospital as emergency.
3)Jaundice:Dangerous during first 3 days of neonatal life.Admit as emergencyfor other jaundice also go to doctor.Dont trust KEELANELLI leaf extract,or any other siddha ayurveda or other herbal treatments.Jaundice after 15 days can be due to surgical congenital cause,if with clay white stools.Jaundice in an unimmunised child at any age could be due to virus infection.Blood test necessary.
4)Diarrhoea:One loose large watery motion needs admission in hospital.3 such motions is often dangerous,unless iv fluid treatment given.Very risky upto age 2 yrsMaximum death rate in this age group.So any home treatment is not advisible.
May try tab lopramideafter 6 months of age.Diarrhoea should stop within 2 hrs.STOP THE FOLLOWING:a)any oral feed b)milk--mothers,/cow's.c)electrolyte powder.d)sweets. e)tender coconut water.If no associated vomiting may try rice water after 2 hrs of lopramide,in small frequent feeds(100 ml/kg /day)
5)Fits:Signifies ,irritation to brain.Needs immediate admission as emergency.Do not put the child in sitting position..put the child lying,face turned to one side&keep a spoon betweenupper 7lower molar teeth,to avoid tongue bite.SUCK OUT MOUTH SECRETIONS.If conscious you can give one tab of Diazapam,orGardinal,especially if he is already a known case of fits.Dont give keys or iron in the hands because it is unscientific.
6)Febrile fits:Fits occuring only during fever episodes in certain children,aged 6months to 6 yrs.Once fever is controlled,fits usually subsides &never reccurs if continuous tepid/ice sponging alone is sufficiently givenIt is necessary that a doctor should rule out it is not brain infection by clinical/ csf exam..A (30 mg-for 10 kgdose of phenobarb(gardinal)(30 mg for 10 kg ,&60 mg for 20 kg child) may be given.
7)Rigor(chills)Abnormal body temperature meckanism as if thermostate function is out of order,
in the brain..Put on a warmer,or heater fan.cover body with blankets.Apply hot water bottle 1--2 is the best.In 10 mts there will be total relief.If not controlled adeqately,give Tab Avil+ dexamethasone.Take him to hospital if no relief within 1 hour.
8)'stomach' pain: If there is no vomiting or diarrhoea,give antacid tabs-3Wait for 15 mts.If no relief ,tab Raftase/CYCLOPAM,WHICH IS GOOD FOR ALL PAINS,INCLUDING MENSTRUAL
DISORDER DIS MENNORRHOEA,OVULATIONPAIN(pain 15 days after menses) kidney stones(Beralgan-drops-tabs)
9)URETHRITIS (Burning micturition).child cries while passing urine,&puts hands over the genitaia & scratches.children above 5 can clearly communicate.give frequent water&tab pyridium,which imparts a brownish red colour to urine.pain disappears in 30 mts like butter on a frying pan.
10)Ear pain:Otogesic/Otec ac/candidwith local anaesthetic drops..Can take one Paracetamol+brufen.
11)foriegn body Eye: Sudden & continuous irritation of Eye.Go to eye specialist immediately.dont try your own treatment.If at night go to government eye hospital Egmore chennai for 24 hr service.
12)Foriegn body-Nose/Ears.:Go to doctor or childrens hospital egmore chennai(24 hrs)
13)accidental poisoning:Children taking blood pressure/diabetes drugs of elders,or any other poisonous substances.If child is CONSCIOUS only,induce vomiting by giving 100- 200 ml of saturated solution of common salt(put salt more so that there is a deposit at the bottom of the vessel.specific antidote can be given at hos pitalIf child is unconscious take him to hospital in LYING POSITION.
14)CHEST PAIN :(Adults above 40 yrs)Left or rt.sidedor central,with or without sweating or reflected to left shoulder or left jaw;Gelusil 3 tabs +1 tab aspirin150 mg,swallowed.1 tab sorbitrate 5 mg kept under tongue.
15)Burns/scalds:Put ice pack all over affected part.sedate ,if pain is severe. tab diazapam1-2 as per age.(5 mg .tab.)
16)SEVERE ITCHING;IN ANY PART OF THE BODY,OR GENERALISED ALL OVER WITH RASHES,?PATCHY THICKENED SKIN(URTICARIA).THE MORE ONE SCRATCHES THE MORE WILL BE ITCHING SENSE: Take tab AVIL+dexamethasone.Flucort ointment for external use if the affected part is very small.If genaralised go to hospital streight.
17)Breath holding spell :Some young children when they cry end up in compleat breathlessness,at the end of the cry&may turn blue.recovers by itslf.stimulate by cold /hot water on the palms/soles.dont give feeds.some times child may throw a fit due to lack of oxygen to brain.
18)Asthma.Not a sudden problem if taking proper medications.Keep a beclamethasone inhaler & give 1-2 puffs,in addition to usual drugs
19)Difficulty in breathing:Put the child in sitting position&not in lying positionDont give feeds when child is restless,till doctor sees.
20)coughing blood/vomiting blood:Emergency admission in hospital with blood transfusion fecility.dont give feeds.transport in sitting position forcough,&lying for vomiting.
21)Insect bites:Tab Avil+Dexamethasone.
22)sleeplessness;Tab?Syp:Diazapam/phenergan
Phenergan should be available in all homes&kept at height not reachable by kids.Good for:-
irritability,sleeplessness,asthma or any wheezing,allergy, coughs,rashes,vomiting,running nose ,pain any where in the body, any insect bite including scorpion sting.It is like Gold or King among the drugs for kids.
23)child's cry over 1-2 hrs:Depends on age &many other factors.There is no way to stop until the cause is foundNo harm to try phenergan syp.
24)Fall from a height:Effect depends upon height &the anatomical part touching the groundfirst.If there is no obvious external injury &if the child is conscious,but for a short cry of 5-10 mts,nothing much to worry.If child stops crying on its own it is good.If the cry is continuous ,take him to doctor.Let him decide.C-T Scan brain may be required if there is a blunt head injury.
25)Cuts/wounds/lacerations/fractures:Dont take any risk for head injuries.All city govt.hospitals equiped with Neuro centeres,for 24 hr service.
For any obvious fractures,or severe pain+inability to move any part:fold 1-2 pages of News paper as splint&keep it at center of deformed part&bandage along with the folded news paper,for immobilisation.
small cuts, lacerations:Clean it with dettol if possible,or apply sterile gause dressings(available in medical shop).INJ.TETANUS TOXOID CAN BE TAKEN LEISURLY.
Keep a first aid box to contain,dressings &all other medicines mentioned in this article(4 tabs in each variety)
It may be stressed that school children may be put to work for 1-2 hrs a week in a doctors clinic as a hobby or pastime so that he can not only learn how to practice first aid on demand when need arises,but also develope interest to become a doctor in later life that will be not only be useful to him but also to the community.
Keep the telephone numbers of the following written in the calender for ready reference;
Ambulance,nearest medical college hospital,fire,leading private hospitals,nearest doctor's clinic ,,residence,any small hospital for ambulance service only, poison controlcenter,casuality department of any big hospital.

C H I L D H O O D --O B E S I T Y .

Introduction:4- 5 decades backPediatricians were more conserned,with malnutrition(Kwashiorkor,Marasmus) management.Thoough it was essentially disorder of poverty, ignorance & illiteracy also played their parts..Now doctors very often see during examination of school children about 10% sufferining frim Obesity,&another 10% with overweight. This shows that there is no poverty now&litracy has done no contribution to stop Obesity in children. Ignorance level continues to be same.There seems to be little awareness about child's obesity & its attendant complications. For all disease &disorders prevention is the best. If diagnosed earlier,it is easily controllable &manageable.

Is your child chubby or obese?
1)what is obesity?Is it same like overweight?
Over weight means more weight for a perticular height.Obesity meansbeing more fatty +over weight,&is calculated as per Body Mass Index.
BMI=WEIGHT IN KG/HEIGHT IN SQUARE METERS.
2) WHAT ARE THE COMPLICATIONS OF OBESITY?
a)difficulty in breathing while walking ,or at rest.
b)difficulty in walking.
c)short life expectancy
d)diabetes mellitus-type II
e) heart disease.
f)cancer
g)depression
h)stress urinary incontinence
i)lower quality of life.
j)high blood pressure
k)high blood cholesterol
l)sleep apnoea(cessation of breathingwhile sleeping)
J)G E R D
K)osteo arthritis.
l)joint pain.
m)female reproductive health disorder.
3)How does BMI helps?.
Yes it does in many ways.There is a graph available(similar to road to health chart)with which a person's bmi CAN BE ASSESSED READILYby plotting height & weight to find out if a given person,belongs to following catagory for clinical assessment/treatment.
BMI-less than 17.5=malnutrition(anorexia nervosa)
BMI18.5--25 =optimal(normal)
BMIless than 18.5 =under weight.
BMI more than 25 =over weight
BMI more than 30 =obesity.
(All the above are applicable to children only)
4)Is it connected to endocrine problems?
Yes. The following endocrine disorders could be the cause for obesity.
a)Thyroid(blood test for T3 ,T4,TSH.)
b)PITUITARY.(BLOOD HORMONE ASSAY)
c)LIPID DISORDER.(BLOOD LIPID PROFILE--CHOLESTROL ANALYSIS)
d)CUSHING'S SYNDROME.(ADRENAL GLAND-HYPER FUNCTION)-HORMONE ASSAY
5)When do we suspect endocrine problem when a child is obese?

If a child at any age upto 12 has any or many of thefollowing clinical problems it is a fitting case to be reffered to a pediatric endocrinologist:
a)polycystic overy.(scan -abdomen)
b)high cholestrol blood(blood lipid profile)
c)high blood pressure.
d)BP+abnormal potassium(serum electrolytes)
e)unusual stretch marks anywhere in the skin.
f)weight gain centered around abdomen+thin extrimities.
g)weight gain with aesy bruising.
h)weight gain without adequate food
i)irregular menses+ or _ abnormal hair growthj
j)if left untreated may have pregnancy related complications in adult life.

6)what is the treatment?
Find out &treat the cause.Every text book says diet +exercise.Any experienced physician over 40 yrs of service will agree upon only one treatment:50-70% weight lossoccurs only on BARIATRIC SURGERY.Diet &excercise are useless in todays concept,if obesity is labelled.
7)Is it preventable? When does it become identifiable?
To a great extant it is preventable if the root cause is diagnosed early.Like ,vaccine preventable diseases parents must take suitable steps to identify early&prevent obesity by appropriate means.
Few recommended steps:
a)well baby?well child health check ups--yearly once.
b)systamatic plotting of road to health chart,upto 12 years.
c)Alteration in eating habits must be watched(whether over eating too much NV items)
Auther's true relevent story.:
10 yr old female child weighing 80 kgs.On questioning about diet history, she said she will go to her fathers restaurent daily after school hours &eat fried chicken legs-6 pieces .Now the readers can tell the treatment.
d)once obesity is confirmed--surgery is the answer.

About S M O K I N G.

ALSO WRITTEN FOR THE PARENTS of adolescent boys.Typically starts only in the adolescent age.Very few start after age 25.Majotity start after seeing a cinema where the villain often smokes..some think that they may look smarter &more presentable before girls.The fact is girls hate smoking.One elderly man told once,"If you want to start smoking,drinking etc start after 25.You will know the hazards &drawbacks behind it."One of the quick addiction forming habit.The drug Nicotine from tobaccostimulates the body to secrete more steroides which gives a false sense of strength,&a sense of well being.
plus points: nil.
Minus points:
1)prohibited in the office& public places.
2)poeple dislike this pungent odour.
3)Individual's reputation usually under estimated.
4)Damages the whole of respiratory pathway including lungs
5)Important cause of cancer.
6)Can cause blood vessel disease,blocking the blood flow to fingers &toes,resulting in the death &dissappearence of fingers &toes(Reynaurd's disease)
7)Considered an important cause of heart attck.
8)Causes sluggish bood flow to brain,due to increased bood viscosity.
9)Robs your putse.
10)May distract attentionwhile driving
11)Can cause fire accident in the car or house or any where
How to get rid of the habit?
Those who want to smoke or already smoking should do the following test&then decide whether to smoke or not.
Test:Take good puff of cigerette smoke ,hold the breath for a while&blow it over a paper or a hand kerchief close to mouth & see the effect.You will find a surprise.There will be hole in the paper or cloth .After seeing this let them decide.If one resorts to smoke after this test,it is short of commiting suicide--a psychological abberation.One wise man told"Cigerett is one ,with a fire at one end & a fool's mouth at the other"
Treatment:Same way like any de-addiction procedure with a qualified doctor.Best is careful supervision in the young age by parents& nip it in the bud itself.

About A L C O H O L

"It provokes the desire, but takes away the performance"--WILLIAM SHAKESPERE.
If a person starts ttaking the habit of drinking alcohol ,in the adolescent age ,he is most likely to be come an addict.If he tastes it around 25yrs of age he could have controle over it.This philosophy is mostly truewith all bad habits.DRUGS like opium alkaloides ,once started ,that is the beginning as well as end & other norcotics once started will get awy only at one place--the graveyard .This is written for the parents of adolecent boys.
Alcohol-plus points.:(only in moderate quantity)
1)It increases appetite.
2)Gives a pleasurable sensation.
3)Gives a good sleep.
4)Provokes sexual desire.
Alcohol--minus points.
1)stomach&bowel ulcer.(constant severe stomach pain-unbearable)
2)Leather bottle stomach or beer drinkers stomach(stomach functions drastically drops down)
3)Liver cirrhosis(multiple scar tissue formation,leading to reduced function.
4)Increased blood pressure(never comes down)
5)Altered behaviour pattern.
6)Inability to do office work.
7)Inability to maintain good posture.
8)Early Diabetes,or aggravation of exhisting diabetes.
9)Tremor of fongers &hands.
10)Gives a false sense of belief,&false self confidence.May result in bad driving,leading to accidents or fighting with a person stronger than him,or commit a serious crime.After blood alcohol level comes down they realise that they were in a false world.
11)Addiction forming drug:After a certain stage (variable from person to person),he feels that he can not be without it.IF HE DOES SO ,HE WILL DEVELOPE,sleeplessness,subjective sensation of heart beats,fits,jitteriness tremors,psychological depression muscle crampsabdominal pain, suicidal tendency,etc, etc.Once he developes drug dependencyif alcohol is withdrwan,he will pose an unmanageblehome situation&suffer from Delerium tremons.The habit should be nipped in the bud itself by the parents or other responsible persons.If mother knows that there is an element of suspision in the boy"s behaviour ,she should not hide it from her husband.
12)Steals your money purse.
How to prevent alcoholism?
There are many ways.
Use of drugs;1)There is a drug called ANTABUSE.If taken 30 mts before alcohol,he will develope severe vomiting after alcohol consumption,that it leaves a wretched feeling &hatred towards alcohol.
2)Use of other sedative drugs by doctors,in the place of alcohol&slowly taper down &stop that drug.
3)Hypnotism:(brain washing)Psychological approach to make him accept to give up alcohol,by councelling.
4)After developing chronic alcoholism addiction is the rule.The one & only & the best wayis preventionEvery alcoholic should realise that he is going to be a potential addict,&he is going to develope,high BP diabetes,&liver damage.So HE SHOULD DEVELOPE A MODERATE habit
in the begining years of drinking itself.There are many who drink only on saterdays ,sundays for decades & nothinh bad happened to them.Their way of drinking is usually differentfrom many others .They take about 30 ml 200 ml of water &drink over a period of 45-60 mts,&not more than 2 drinksThey dont drink for the sake of" KICKS" It is meant for pleasure or elated mood,not for kicks.No morning or after noon drinkiong.No late night drinking.No drinking in the bar excapt at residence.No drinking with a group.Drinking should be done in a style,like "Hold the bottle by the neck,&hold a woman by the waist"These are some of the ways by which a man can avoid being a druncard,or an addict.