PRACTICAL PEDIATRIC PSYCHOLOGICAL COUNSELLING FOR PARENTS.
We have to concentrate on 4important points only:
1)children hate parental control.
2)children have interest in socialisation.
3)bad society /bad friendship often turns good into spoiled children.
4)child gives priority to fraternal control than maternal.
PARENTAL CONTROL.
-----------------
EVERY CHILD STARTS LEARNING RIGHT FROM BIRTH SOMETHING EVERY HOUR &EVERY DAY
Parents have to provide suitable opportunity,for environmental stimulation for such learning&it is a continuous process,never ending as long as brain functions keep steering
in the normal way.Generally child wants to be independent age 2.They want to eat themselves,though they will do it in a clumsy way. they get used to in due course.
The 2-3 year age group is bestowed with boundless energy&they can be controlled only when their energy level comes down,after a physically tiresome play..When father returns home child will take the privilege of playing with father in an aggressive way.Father is expected to control his emotions.Sizable number of fathers return home fully boozed.Drunken man can not be expected to know how to behave with a child.The result is a gradual demoralisation of child ending up in a child with low I.Q.,OR LOW ACADEMIC PERFORMANCE,or become a school dropout.Beating such children will not only worsen the situation,but may lead to a psychological breakdown situation There after it is not retrievable most often&that is the end.
so prophylaxis is better than cure.
SOCIALISATION;
Animals are social&man is a social animal.From early child hood he wants to play with other children.or pet animals.This is not practicable in U.S.A..(Playing with pet animals is contraindicated)The culture in India differs in this respect with U.S.A
children US see other children only in parties once a month.otherwise there imprisoned inside
4 walls.only person to see is mother.few children are privileged to go to daycare centers.
JAMBOREE where they see other children&many play equipments..In major hospitals,specially teaching institutions,there is a department known as occupation therapy..meant for mentally &physically retarded children.Even normal children can be exposed to this department&can be found beneficial in sharpening the mental make up of children without any doubts
BAD FRIENDSHIP
Tell me your friend,I will tell your character,is an old proverb.Child grownup child,early adolesents dont know how to select good friends.It is the duty of parents to advise them about their friends&how to choose good from the bad.Children naturally make friendship with high scoring children only if they themselves are high scorers.this HAS TO BE CONFIRMED BY PARENTS,NOW &THEN
parents SHOULD ORGANISE PARTIES ONCE IN A WAY FOR THE CHILD'S SAKE.This provides an opportunity
to study the character of the child's "friends circle".
This should be maintained till child enters college ADOLESCENT AGE IS ONE OF THE MOST DIFFICULT PART OF A CHILD'S DEVELOPMENTAL STAGE.&IS OFTEN A CHALLENGING TASK.
Boy or girl,they are very defiant often &parents have to make right decision to have a good command &control over the child.If not they should seek the help of school teacher or headmaster, or a senior educated relative or even police as the last measure.If child is brought
up well &moulded properly from early childhood.all these things may not be necessary
CHILD IS MORE OBEDIENT TO FATHER THAN MOTHER
In the absence of father ,he very obedient to mother.When father returns home at 6 pm,he is relatively less obedient to mother.This should be considered as a sign of intelligence.&no abuse or threat to be used,towards the child.Obedience is one the most important mental faculty
required to be developed gradually.As age advances,different technique to be used to inculcate discipline.Abusing &beating should never be resorted to ,at any age,as it would only further deteriorate there situation.Parents should approach intellectually to control stubbornness.If they do not know let them go to a pediatric psychologist.Small threatening measures like "TIME OUT" may be practiced whenever they do a wrong thing,&to make them understand,what is right.Intelligence level keeps on increasing every year.&by about age 5 they should obey 100%IF CONTRARY IS FOUND,CONSULT PSYCHOLOGIST.Children like parents always to be smiling &playful towards them(irrespective of their own mental conflicts This may be difficult though.on such occasions parents require PATIENCE.Keep the children always in playful activity,or some kind of useful,intellectual occupation,so that children become less mischievous,or less boisterous.All these are easy to preach but difficult to practice.
Monday, December 21, 2009
Thursday, December 17, 2009
NEWMUMS DOUBTS ABOUT HER NEW BORN-CLARIFIED
1)CRY
GENARALLY THIS IS A NORMAL SIGN OF LIFE.SOMETIMES IT IS ABNORMAL &NEEDS DOCTOR'S DIAGNOSIS.
SEE MY ARTICLE-CRY-60 CAUSES IN THIS BLOG.
VISIT MY ARTICLE ENTITLED- 4-8 PM SYNDROME IN THIS BLOG.
2)VOMITING.MOSTLY ,IT IS REGURGITATION DUE TO IMPROPER BURPING.WHEN BABY SWALLOWS MILK,IT DOES ALONG WITH SOME AIR ALLWAYS.THAT HAS TO COME OUTBY BURPING.(PUT BABY ON SHOULDER &TAP GENTLY ON BACKTILL GASS COMES UOT 2-3 TIMES..IF IT IS VOMITING IT MAY BE DUE TO STOMACH INFECTION DUE
TO AMNIOTIC FLUID SWALLOWING.RARELY IT MAY BE BRAIN RELATED.ALSO IT CAN BE DUE TO IMPROPER (LESS) DEFECATION OF MECONIUM(MECONEUM ILEUS SYNDROMEWHEN VOMITING CAN LAST FOR 3-5 DAYS.RELIEF OBTAINED MEDICALLY /SURGICALLY.
3)CONSTIPATION:FIRST BLACK STOOL(MECONEUM)PASSED UPTO 3DAYS.GOLDEN YELLOW COLOUR FROM FOURTH DAY..IF NO MOTION LOOK FOR VOMITING /ABDOMINAL DISTENSION.SUSPECT CONGENITAL DEVELOPEMENT PROBLEM OF INTESTINES.SOMETIMES ATRESIAS.SOMETIMES HISPRUNG'S DISEASE.SOMETIMETIMES PASSING MOTION ONCE IN 10-15 DAYS CAN BE NORMAL!(ILLINGWORTH)
4)STRAINING:DURING DEFECATION/MICTURITION.THIS IS NORMAL.BAY IS EXPLORING NEW KNOWLEDGETHAT STRAINING RELIEVES BOWEL/BLADDER!.
5)URINATION:URINE IS HOT.--NORMAL
6)FEEDING50% OF BABIES DONT FEEDPROPERLYDUE TO:
A)LACK OF BREAST FEEDING TECHNIQUE&POSITION.
B)RETRACTED NIPPLES.
C)INSUFFICIENT HYDRATION&MATERNAL NUTRITION
D)SOMETIMES OBSTRUCTION TO MILK FLOW DUE TO THICK COLOSTRUM(TAMIL-SEEM-PAAL)
7)UMBILICAL STUMP:USALLY FALLS ON SEVENTH DAY.SOMETIMES MAY STAY UPTO21 DAYS!,WHEN IT IS REMOVED SURGICALLY.BEWARE OF UMBILICAL SEPSIS.DONT RUSH TO GIVE BATHBEFORE 15 DAYS.CAN GIVE SPONGE BATH INSTEAD.CLEAN AXILLA,GENITALS,NECK ONLY.
8)BATH:GIVEN 3 DAYS AFTER FALL OF UMBILICAL STUMP.NO OIL BATH.NO SOAPNUT POWDER USE.NO NEED FOR BATH IN WINTER.DAILY BATH NOT REQUIRED.HEAD BATH ONCE A MONTH IF THERE IS BAD ODOUR.
9)WATER FEEDS GIVEN TWICE DAILY BETWEEN FEEDS.
10)DONT DO OILING TO EAR /NOSE.
11)CASTEROIL/PURGATIVES USE-CONTRAINDICATED.
12)SKIN -OILING.INDICATED IF SKIN IS DRY.
13)TOILET POWDER USE- CONTRAINDICATED.
14)PHYMOSIS:FORESKIN -PENIS MAY HAVE PIN HOLE MEATUS.MAY RQUIRE DILATATION OF FORESKIN
ONLY.
15)BLOOD PER VAGINA-DE TO EXCESS OESTROGENWITHDRAWAL.NO TREATMENT NECESSARY.
16)BREAST ENLARGEMENT,IN EITHER SEX.:ALSO DUE TO HIGH MATERNAL ESTROGEN IN CIRCULATION.
NO TREATMENT REQUIRED.
17)LACRIMATION SOMETIMES DUE TO NASOLACRIMAL DUCT OBSTRUCTION.SOME TIMES NORMAL.
SOMETIMESREQUIRES,MEDICAL PHYSIOTHERAPY/SYRGERY.
18)BLEEDING DIATHESIS:BLEEDING PER NOSE/MOUTH.DUE TO COAGULATION FACTER DEFFICIENCY.
DIAGNOSIS FIRST-TREATMENT NEXT.
19)HEARING:B E R A -SUPER SPECIAL HEARING TEST AVAILABLE FOR NEWBORNS.
20)VISION:CONFIRMED WITHIN 30 DAYSBY PEDIATRITICIANS.
GENARALLY THIS IS A NORMAL SIGN OF LIFE.SOMETIMES IT IS ABNORMAL &NEEDS DOCTOR'S DIAGNOSIS.
SEE MY ARTICLE-CRY-60 CAUSES IN THIS BLOG.
VISIT MY ARTICLE ENTITLED- 4-8 PM SYNDROME IN THIS BLOG.
2)VOMITING.MOSTLY ,IT IS REGURGITATION DUE TO IMPROPER BURPING.WHEN BABY SWALLOWS MILK,IT DOES ALONG WITH SOME AIR ALLWAYS.THAT HAS TO COME OUTBY BURPING.(PUT BABY ON SHOULDER &TAP GENTLY ON BACKTILL GASS COMES UOT 2-3 TIMES..IF IT IS VOMITING IT MAY BE DUE TO STOMACH INFECTION DUE
TO AMNIOTIC FLUID SWALLOWING.RARELY IT MAY BE BRAIN RELATED.ALSO IT CAN BE DUE TO IMPROPER (LESS) DEFECATION OF MECONIUM(MECONEUM ILEUS SYNDROMEWHEN VOMITING CAN LAST FOR 3-5 DAYS.RELIEF OBTAINED MEDICALLY /SURGICALLY.
3)CONSTIPATION:FIRST BLACK STOOL(MECONEUM)PASSED UPTO 3DAYS.GOLDEN YELLOW COLOUR FROM FOURTH DAY..IF NO MOTION LOOK FOR VOMITING /ABDOMINAL DISTENSION.SUSPECT CONGENITAL DEVELOPEMENT PROBLEM OF INTESTINES.SOMETIMES ATRESIAS.SOMETIMES HISPRUNG'S DISEASE.SOMETIMETIMES PASSING MOTION ONCE IN 10-15 DAYS CAN BE NORMAL!(ILLINGWORTH)
4)STRAINING:DURING DEFECATION/MICTURITION.THIS IS NORMAL.BAY IS EXPLORING NEW KNOWLEDGETHAT STRAINING RELIEVES BOWEL/BLADDER!.
5)URINATION:URINE IS HOT.--NORMAL
6)FEEDING50% OF BABIES DONT FEEDPROPERLYDUE TO:
A)LACK OF BREAST FEEDING TECHNIQUE&POSITION.
B)RETRACTED NIPPLES.
C)INSUFFICIENT HYDRATION&MATERNAL NUTRITION
D)SOMETIMES OBSTRUCTION TO MILK FLOW DUE TO THICK COLOSTRUM(TAMIL-SEEM-PAAL)
7)UMBILICAL STUMP:USALLY FALLS ON SEVENTH DAY.SOMETIMES MAY STAY UPTO21 DAYS!,WHEN IT IS REMOVED SURGICALLY.BEWARE OF UMBILICAL SEPSIS.DONT RUSH TO GIVE BATHBEFORE 15 DAYS.CAN GIVE SPONGE BATH INSTEAD.CLEAN AXILLA,GENITALS,NECK ONLY.
8)BATH:GIVEN 3 DAYS AFTER FALL OF UMBILICAL STUMP.NO OIL BATH.NO SOAPNUT POWDER USE.NO NEED FOR BATH IN WINTER.DAILY BATH NOT REQUIRED.HEAD BATH ONCE A MONTH IF THERE IS BAD ODOUR.
9)WATER FEEDS GIVEN TWICE DAILY BETWEEN FEEDS.
10)DONT DO OILING TO EAR /NOSE.
11)CASTEROIL/PURGATIVES USE-CONTRAINDICATED.
12)SKIN -OILING.INDICATED IF SKIN IS DRY.
13)TOILET POWDER USE- CONTRAINDICATED.
14)PHYMOSIS:FORESKIN -PENIS MAY HAVE PIN HOLE MEATUS.MAY RQUIRE DILATATION OF FORESKIN
ONLY.
15)BLOOD PER VAGINA-DE TO EXCESS OESTROGENWITHDRAWAL.NO TREATMENT NECESSARY.
16)BREAST ENLARGEMENT,IN EITHER SEX.:ALSO DUE TO HIGH MATERNAL ESTROGEN IN CIRCULATION.
NO TREATMENT REQUIRED.
17)LACRIMATION SOMETIMES DUE TO NASOLACRIMAL DUCT OBSTRUCTION.SOME TIMES NORMAL.
SOMETIMESREQUIRES,MEDICAL PHYSIOTHERAPY/SYRGERY.
18)BLEEDING DIATHESIS:BLEEDING PER NOSE/MOUTH.DUE TO COAGULATION FACTER DEFFICIENCY.
DIAGNOSIS FIRST-TREATMENT NEXT.
19)HEARING:B E R A -SUPER SPECIAL HEARING TEST AVAILABLE FOR NEWBORNS.
20)VISION:CONFIRMED WITHIN 30 DAYSBY PEDIATRITICIANS.
Sunday, December 13, 2009
BABY-CRY-TREATMENT TIPS
BABY CRY TREATMENT TIPS:TO JUNIOR PEDIATRICIANS
1)NEVER EXAMINE WITHOUT SEDATION.
2)CAN BOLDLY SEDATE WITH TWO DRUGS,IF NOT SEDATED WITH SINGLE DRUG.
3)AVOID USING TRICHLORYL(TRICHLOPHOS),AS IT MAY PRODUCE RENAL FAILURE IF REPEATED.
4)SAFEST SEDATIVE DRUGS;PHENERGAN,PHENOBARBITONE,DIAZAPAM,LARGACTIL.
5)IF CHILD CONTINUES TO CRY FOR MORE THAN 6 HOURS/DAYS,IF CAUSE IS NOT KNOWN,BRING DOWN TACHYCARDIA BY A DOSE OF DIGOXIN+FRUSAMIDE.I.V..IF THE HEART RATE COMES DOWN,BABY WILL GO TO SLEEP ONLY TO GET UP FRESH TO PLAY ACTIVITY.THE PRESUMPTIVE DIAGNOSIS HERE IS C.C.F.DUE TO VIRAL
MYOCARDITIS.NEEDLESS TO SAY IT MAY REQUIRE OTHER TREATMENT FOR CORRECTING THE CAUSATIVE FACTORS.
1)NEVER EXAMINE WITHOUT SEDATION.
2)CAN BOLDLY SEDATE WITH TWO DRUGS,IF NOT SEDATED WITH SINGLE DRUG.
3)AVOID USING TRICHLORYL(TRICHLOPHOS),AS IT MAY PRODUCE RENAL FAILURE IF REPEATED.
4)SAFEST SEDATIVE DRUGS;PHENERGAN,PHENOBARBITONE,DIAZAPAM,LARGACTIL.
5)IF CHILD CONTINUES TO CRY FOR MORE THAN 6 HOURS/DAYS,IF CAUSE IS NOT KNOWN,BRING DOWN TACHYCARDIA BY A DOSE OF DIGOXIN+FRUSAMIDE.I.V..IF THE HEART RATE COMES DOWN,BABY WILL GO TO SLEEP ONLY TO GET UP FRESH TO PLAY ACTIVITY.THE PRESUMPTIVE DIAGNOSIS HERE IS C.C.F.DUE TO VIRAL
MYOCARDITIS.NEEDLESS TO SAY IT MAY REQUIRE OTHER TREATMENT FOR CORRECTING THE CAUSATIVE FACTORS.
Saturday, December 12, 2009
BABY-CRY-60 CAUSES
ANY OR MANY OF THE FOLLOWING COULD BE THE CAUSE FOR A BABY'S CRY.COMPLETE &THOROUGH EXAMINATION OF THE NAKED BODY FROM HEAD TO FOOT HELPS DIAGNOSIS.
PERCENTAGE CONSTITUTION.:
A)FIRST 5 =95% B)NEXT 15- =4%.C)NEXT-4O=1%
CAUSES:60 IN NUMBER.
1)HUNGER
2)SLEEP
3)DIAPER CHANGE.
4)ATMOSPHERIC TEMPERATURE
5)DISTURBING ENVIRONMENT-
Eg;TOO MUCH SOUND,PEOPLE TALKING TOO LOUD,CROWDED PLACE.
-------------------------------------------------------
6)VOMITING SENSE
7)GASTRO ESOPHAGEAL REFLUX
8)ACIDITY
9)INTESTINAL COLIC
10)OBSTIPATION/CONSTIPATION
11)URETHRITIS
12)ASOM(MILK ENTERING EARS FROM MOUTH)
13)FOREIGN BODY EYES.
14)ITCHING SENSE
15)ALLERGIC NASAL OBSTRUCTION
16)ALLERGIC BRONCHITIS.!
17)MILK INTOLERANCE.
18)LACTOSE/GALECTOSE INTOLERANCE.
19)ACUTE BRONCHIOLITIS/WHEEZY BRONCHITIS.
20)IRRITATING JEWELLERY/COSTUMES.
--------------------------------
21)FUNGAL INFECTION
22)HEAD LICE/LICE-EYE LASHES.
23)CONGENITAL HEART DISEASE
24)HARE LIP/CLEFT PALATE.
25)HISPRUNG'S DISEASE
26)ANAL STENOSIS
27STRICTURE URETHRA
28)URINARY TRACT INFECTION
29)UROLITHIASIS
30)HAEMATURIA
31)AMINOACIDURIA
32)MAPLE SYRUP URINE DISEASE
33)JET LAG(SLEEP DISTURBANCE)
34)LOW HUMIDITY-UK/USA.CAUSING DRYNESS OF RESPIRATORY MUCOSA.
35)OSTEOMYELITIS
36)PYOGENIC ARTHRITIS.
37)LACK OF MOTHER'S WARMTH-BONDING.
38)IMPROPER BURPING
39)CHILL BLAINS.
40)PUNGENT ODOURS
41)DENTAL ERUPTIONS(AGE AROUND 6 MONTHS)
42)WORM COLIC.
43)CRYSTA LURIA
44)RENAL COLIC
45)CHOLISISTITIS
46)HEPATITIS
47)CRYING CONVULSIONS
48)PRURITIS ANI
49)TORTION TESTIS
50)DIAPHRAGMATIC HERNIA
51)MYOCARDITIS/CCF
52)EMPYEMA
53)SHAKEN BABY SYNDROME
54)SPRAIN NECK(VORUM VIZHUDAL-TAMIL--AGE BELOW 6 MONTHS USUALLY)
55)FRACTURE CLAVICLES(MISHANDLING)
56)INSECT BITE
57)SCORPION STING (SKIN COLDNESS DUE TO PERIPHERAL CIRCULATORY FAILURE)
58)LONELINESS/FEAR COMPLEX
59)FEVER/HYPERPYREXIA
60)BATTERED BABY SYNDROME.
PERCENTAGE CONSTITUTION.:
A)FIRST 5 =95% B)NEXT 15- =4%.C)NEXT-4O=1%
CAUSES:60 IN NUMBER.
1)HUNGER
2)SLEEP
3)DIAPER CHANGE.
4)ATMOSPHERIC TEMPERATURE
5)DISTURBING ENVIRONMENT-
Eg;TOO MUCH SOUND,PEOPLE TALKING TOO LOUD,CROWDED PLACE.
-------------------------------------------------------
6)VOMITING SENSE
7)GASTRO ESOPHAGEAL REFLUX
8)ACIDITY
9)INTESTINAL COLIC
10)OBSTIPATION/CONSTIPATION
11)URETHRITIS
12)ASOM(MILK ENTERING EARS FROM MOUTH)
13)FOREIGN BODY EYES.
14)ITCHING SENSE
15)ALLERGIC NASAL OBSTRUCTION
16)ALLERGIC BRONCHITIS.!
17)MILK INTOLERANCE.
18)LACTOSE/GALECTOSE INTOLERANCE.
19)ACUTE BRONCHIOLITIS/WHEEZY BRONCHITIS.
20)IRRITATING JEWELLERY/COSTUMES.
--------------------------------
21)FUNGAL INFECTION
22)HEAD LICE/LICE-EYE LASHES.
23)CONGENITAL HEART DISEASE
24)HARE LIP/CLEFT PALATE.
25)HISPRUNG'S DISEASE
26)ANAL STENOSIS
27STRICTURE URETHRA
28)URINARY TRACT INFECTION
29)UROLITHIASIS
30)HAEMATURIA
31)AMINOACIDURIA
32)MAPLE SYRUP URINE DISEASE
33)JET LAG(SLEEP DISTURBANCE)
34)LOW HUMIDITY-UK/USA.CAUSING DRYNESS OF RESPIRATORY MUCOSA.
35)OSTEOMYELITIS
36)PYOGENIC ARTHRITIS.
37)LACK OF MOTHER'S WARMTH-BONDING.
38)IMPROPER BURPING
39)CHILL BLAINS.
40)PUNGENT ODOURS
41)DENTAL ERUPTIONS(AGE AROUND 6 MONTHS)
42)WORM COLIC.
43)CRYSTA LURIA
44)RENAL COLIC
45)CHOLISISTITIS
46)HEPATITIS
47)CRYING CONVULSIONS
48)PRURITIS ANI
49)TORTION TESTIS
50)DIAPHRAGMATIC HERNIA
51)MYOCARDITIS/CCF
52)EMPYEMA
53)SHAKEN BABY SYNDROME
54)SPRAIN NECK(VORUM VIZHUDAL-TAMIL--AGE BELOW 6 MONTHS USUALLY)
55)FRACTURE CLAVICLES(MISHANDLING)
56)INSECT BITE
57)SCORPION STING (SKIN COLDNESS DUE TO PERIPHERAL CIRCULATORY FAILURE)
58)LONELINESS/FEAR COMPLEX
59)FEVER/HYPERPYREXIA
60)BATTERED BABY SYNDROME.
DOUBTS OF NEW MUM NEW BORN RELATED
---------------------------------------
1)BABY IS CRYING OFTEN/NOT CRYING.
CRY IS THE ONLY WAY,A NEONATE CAN COMMUNICATE TO THE WORLD.CRY IS OFTEN SLEEP RELATED, OR WET DIAPER OR UNBEARABLE EXTERNAL TEMPERATURE+HUMIDITY OR WANT OF SLEEP OR SOME IRRITATING/STRESSFUL ATMOSPHERE(TOO MUCH OF SOUND, TOO MUCH OF LIGHT)THE PATTERN OF CRY IS DIFFERENT FOR EACH & MOTHER NEEDS TO IDENTIFY CORRECTLY.
BABY MAY NOT CRY BECAUSE THE SLEEP REQUIREMENT IS ABOUT 18 HOURS/DAY&MAY CRY ONLY FOR FEEDS/DIAPER CHANGE.
FOLLOWING ARE OTHER QUESTIONS ASKED BY NEW MUMS:
1)CRY---SEE60 CAUSES IN MY NEXT ARTICLE.
2)VOMITING
3)CONSTIPATION
4)STRAINING DURING MICTURITION,DEFECATION.
5)MICTURITION
6)FEEDING
7)UMBILICAL STUMP
8)BATH(HEAD BATH)
9)WATER FEEDS.
10)OILING TO EARS.
11)CASTER OIL/PURGATIVES.
12)OILING TO SKIN.
13)TOILET POWDER USE
14)PHYMOSIS.
15)BLOOD PER VAGINA(Baby's)
16)BREAST ENGORGEMENT.(BOTH SEXES)
17)LACRIMATION(TEARS IN EYES)
18)BLEEDING DIATHESIS.
19)HEARING SENSE.
20)VISION.
21)NATAL TOOTH.
22)DIARROEA DUE TO LACTOSE/GALECTOSE INTOLERANCE
1)BABY IS CRYING OFTEN/NOT CRYING.
CRY IS THE ONLY WAY,A NEONATE CAN COMMUNICATE TO THE WORLD.CRY IS OFTEN SLEEP RELATED, OR WET DIAPER OR UNBEARABLE EXTERNAL TEMPERATURE+HUMIDITY OR WANT OF SLEEP OR SOME IRRITATING/STRESSFUL ATMOSPHERE(TOO MUCH OF SOUND, TOO MUCH OF LIGHT)THE PATTERN OF CRY IS DIFFERENT FOR EACH & MOTHER NEEDS TO IDENTIFY CORRECTLY.
BABY MAY NOT CRY BECAUSE THE SLEEP REQUIREMENT IS ABOUT 18 HOURS/DAY&MAY CRY ONLY FOR FEEDS/DIAPER CHANGE.
FOLLOWING ARE OTHER QUESTIONS ASKED BY NEW MUMS:
1)CRY---SEE60 CAUSES IN MY NEXT ARTICLE.
2)VOMITING
3)CONSTIPATION
4)STRAINING DURING MICTURITION,DEFECATION.
5)MICTURITION
6)FEEDING
7)UMBILICAL STUMP
8)BATH(HEAD BATH)
9)WATER FEEDS.
10)OILING TO EARS.
11)CASTER OIL/PURGATIVES.
12)OILING TO SKIN.
13)TOILET POWDER USE
14)PHYMOSIS.
15)BLOOD PER VAGINA(Baby's)
16)BREAST ENGORGEMENT.(BOTH SEXES)
17)LACRIMATION(TEARS IN EYES)
18)BLEEDING DIATHESIS.
19)HEARING SENSE.
20)VISION.
21)NATAL TOOTH.
22)DIARROEA DUE TO LACTOSE/GALECTOSE INTOLERANCE
Tuesday, December 1, 2009
UMBILLICAL HERNIA-NON SURGICAL TREATMENT
UMBILICAL HERNIA-NON SURGICAL TREATMENT
----------------------------------------
THIS IS A CONGENITAL DEFECT IN CHILDREN.IF IT IS SMALL CONSERVATIVE MEASURES ARE ENOUGH.
IF IT IS LARGE ,SURGERY IS THE ANSWER.MANY YOUNG INFANTS DO NOT GET PROPER ADVISE ON CONSERVATIVE TREATMENT.MOTHERS ARE ADVISED USUALLY ABOUT APPLICATION OF A COIN OF 2 CM DIAMETER IS APPLIED&BANDAGED OVER THE DEFECT FOR 3-6MONTHS,WHEN IT MIGHT SHOW AUTOMATIC CLOSURE OF DEFECT.
THE BETTER WAY OF DOING THIS IS APPLICATION OF A SMALL PLASTIC BALL,LIKE PING -PONG BALL
OR A MEDIUM SIZED INDIAN LIME FRUIT(AMERICAN LIME IS 8 TIMES BIGGER!).THE ADVANTAGE IS THAT THE BALL WONT SLIP AWAY UNLIKE THE COIN.THIS IS QUITE SAFE &HAS NO SIDE EFFECT.THE SIZE OF HERNIA OFTEN BECOMES LARGER DUE TO FREQUENT CRIES OF THE CHILD THAT INCREASES THE INTRA ABDOMINAL PRESSURE,FORCING THE HERNIAL SAC WITH BOWEL TO PROTRUDE OUTSIDE WHEN THE HERNIAL ORIFICE(UMBILICUS)IS NOT SUPPORTED BY A BALL LIKE OBSTRUCTION.EVEN IF INFANT CRIES THE BALL IS USUALLY RETAINED IN THE SAME PLACE&APPEARS TO BE IDEAL IF A PING-PONG BALL IS USED.
----------------------------------------
THIS IS A CONGENITAL DEFECT IN CHILDREN.IF IT IS SMALL CONSERVATIVE MEASURES ARE ENOUGH.
IF IT IS LARGE ,SURGERY IS THE ANSWER.MANY YOUNG INFANTS DO NOT GET PROPER ADVISE ON CONSERVATIVE TREATMENT.MOTHERS ARE ADVISED USUALLY ABOUT APPLICATION OF A COIN OF 2 CM DIAMETER IS APPLIED&BANDAGED OVER THE DEFECT FOR 3-6MONTHS,WHEN IT MIGHT SHOW AUTOMATIC CLOSURE OF DEFECT.
THE BETTER WAY OF DOING THIS IS APPLICATION OF A SMALL PLASTIC BALL,LIKE PING -PONG BALL
OR A MEDIUM SIZED INDIAN LIME FRUIT(AMERICAN LIME IS 8 TIMES BIGGER!).THE ADVANTAGE IS THAT THE BALL WONT SLIP AWAY UNLIKE THE COIN.THIS IS QUITE SAFE &HAS NO SIDE EFFECT.THE SIZE OF HERNIA OFTEN BECOMES LARGER DUE TO FREQUENT CRIES OF THE CHILD THAT INCREASES THE INTRA ABDOMINAL PRESSURE,FORCING THE HERNIAL SAC WITH BOWEL TO PROTRUDE OUTSIDE WHEN THE HERNIAL ORIFICE(UMBILICUS)IS NOT SUPPORTED BY A BALL LIKE OBSTRUCTION.EVEN IF INFANT CRIES THE BALL IS USUALLY RETAINED IN THE SAME PLACE&APPEARS TO BE IDEAL IF A PING-PONG BALL IS USED.
Saturday, November 21, 2009
MEDICAL CONCEPT -UNPUBLISHED--3
NEW TREATMENT FOR FITS.
----------------------
One of the commonest cause of neonatal fits, is intracranial hemorrhage,&C.T. scan pictures
have been published in Nelson's text book even 40 years back.We now understand that
intracranial hemorrhage can occur antenatal ,perinatal,&post Natal,leading to fits.THERE
ARE FEW CHILDREN BELOW ONE YEAR OF AGE WHO GET UNCONTROLLED CONVULSIONS,BY CONVENTIONAL
ANTICONVULSANTS, IN SPITE OF DETAILED RELEVANT INVESTIGATIONS,WHICH DO NOT COVER ROUTINE BLOOD
COAGULATION PROFILE.Recently this Auther has come across3 children ,below one year , in the
last one year's hospital service,with seizure disorders uncontrolled by three
anticonvulsants(eptoin,phenobarb,sodium valproate)These children had higher values of
prothrombin time/INR,indicating lessened coagulation,&tendency for minute microscopic capillary
bleeds inside the brain.The convulsions have stopped after addition of
ETHAMSILATE(hemostat)&injection of VITAMIN K ,WITHIN 3 MONTHS Though it requires ,a large,systamatic&scientific analyticalstudy in a childrens hospital like ICH MADRAS,
to confirm &conclude it defifinitele indicates that there is a place for including prothrombin
time&inr in the neonatal screeninig procedure&perhaps to all uncontrolled seizure disorders
under 3 anticonvulsant drugs,in the under one year age group children.
----------------------
One of the commonest cause of neonatal fits, is intracranial hemorrhage,&C.T. scan pictures
have been published in Nelson's text book even 40 years back.We now understand that
intracranial hemorrhage can occur antenatal ,perinatal,&post Natal,leading to fits.THERE
ARE FEW CHILDREN BELOW ONE YEAR OF AGE WHO GET UNCONTROLLED CONVULSIONS,BY CONVENTIONAL
ANTICONVULSANTS, IN SPITE OF DETAILED RELEVANT INVESTIGATIONS,WHICH DO NOT COVER ROUTINE BLOOD
COAGULATION PROFILE.Recently this Auther has come across3 children ,below one year , in the
last one year's hospital service,with seizure disorders uncontrolled by three
anticonvulsants(eptoin,phenobarb,sodium valproate)These children had higher values of
prothrombin time/INR,indicating lessened coagulation,&tendency for minute microscopic capillary
bleeds inside the brain.The convulsions have stopped after addition of
ETHAMSILATE(hemostat)&injection of VITAMIN K ,WITHIN 3 MONTHS Though it requires ,a large,systamatic&scientific analyticalstudy in a childrens hospital like ICH MADRAS,
to confirm &conclude it defifinitele indicates that there is a place for including prothrombin
time&inr in the neonatal screeninig procedure&perhaps to all uncontrolled seizure disorders
under 3 anticonvulsant drugs,in the under one year age group children.
Monday, November 2, 2009
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.
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.
Monday, October 26, 2009
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
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
Sunday, October 25, 2009
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
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
Monday, September 28, 2009
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.
Friday, September 25, 2009
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.
Saturday, August 8, 2009
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.
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.
Sunday, February 1, 2009
single visit/ONE JAB POLYIMMUNISATION
FOR JUNIOR PEDIATRICIANS:
Indian &American academy of pediatrics permit children to have vaccination for multiple vaccine preventable diseases,in one shot or two shots on the same day as patient compliance is better.DPT(TRIPLE ANTIGEN),MMR,CHICKENPOX ,Hib ,are usually combined.they have produced unwanted side effects in India&USA,though in a small number The chief ill effect is intracranial hemorrhage sub cutaneous bleeding with reduced platelet count(bone marrow depression).So it is better to give single than double trple in the same,though at different sites.Life is precious,specially for parents..Better to avoid the following combinations:1)Qvac,dtp+hepatitisB
2)PENTAVAC(dtp+hep.B .+Hib. 3)quadrivac(dpt+Hib+4)MMR+varicella.these two are preferably never combined with any other vaccine. DTaP IS PREFERRED OVER DPT.always LEAVE THE DOCTOR'S CLINIC 30 MINUTES AFTER INJECTION TO SEE IF THERE IS ANY IMMEDIATE ANAPHYLACTIC REACTIONS.There are many doctors who advocate multiple injections do no harm.Thes are purly author's views &experience.
Indian &American academy of pediatrics permit children to have vaccination for multiple vaccine preventable diseases,in one shot or two shots on the same day as patient compliance is better.DPT(TRIPLE ANTIGEN),MMR,CHICKENPOX ,Hib ,are usually combined.they have produced unwanted side effects in India&USA,though in a small number The chief ill effect is intracranial hemorrhage sub cutaneous bleeding with reduced platelet count(bone marrow depression).So it is better to give single than double trple in the same,though at different sites.Life is precious,specially for parents..Better to avoid the following combinations:1)Qvac,dtp+hepatitisB
2)PENTAVAC(dtp+hep.B .+Hib. 3)quadrivac(dpt+Hib+4)MMR+varicella.these two are preferably never combined with any other vaccine. DTaP IS PREFERRED OVER DPT.always LEAVE THE DOCTOR'S CLINIC 30 MINUTES AFTER INJECTION TO SEE IF THERE IS ANY IMMEDIATE ANAPHYLACTIC REACTIONS.There are many doctors who advocate multiple injections do no harm.Thes are purly author's views &experience.
Friday, January 30, 2009
unpublished concepts in medicine
there are many.every experienced physician develops his own concept after seeing same cases repeatedly.for years1).mothers are immunised against tetanus,during 6,7,8,th month of pregnancy.if for some reason it was not given better to give late.than never..If no TT given till delivery ,a dose of tetanus immunoglobulin could be given to baby to prevent tetanus neonatorum.2)To all cases of clinical septicaemia,better to give dose of blood transfusion to supply immunoglobulin. 3)in certain selective cases of clinical radiological asthma,antihelminthic may be be given empirically&,as the chief offender is migrating larva repeatedly .4)In certain selective case of rhumatoid disease,where anti rheumatics fail,antimalarial are worth a trial.
Thursday, January 1, 2009
UNPUBLISHED MEDICAL CONCEPT--2
CHILD'S BRAIN &MOTHER'S THYROXIN:
THE NEUROLOGICAL DEVELOPMENT IF HUMAN BRAIN GREATLY DEPENDS UPON THYROXIN HORMONE,IS AN ESTABLISHED FACT.THE DEVELOPING EMBRYO GETS ITS BLOOD SUPPLY,FROM MOTHER WHOSE THYROXIN LEVEL IN BLOOD SHOULD BE ADEQUATE THERE ARE MANY PREGNANT MOTHERS LIVING IN MANY VILLAGES,DRINK WATER WITH LESS IODINE, MAIN SOURCE OF WHICH IS WATER &SALT.AS A RESULT IF AN EMBRYO IS GROWING IN A BLOOD DEPRIVED OF IODINE WILL RESULT IN THE NEURAL TISSUE DEVELOPEMENT BEING QUALITATIVELY AFFECTED.UNLESS THE BLOOD LEVEL OF IODINE ARE MONITORED THRICE DURING PREGNANCY HYPOTHYROID STATE DEVELOPING BECOMES INEVITABLE.A BABY BELOW SUB CLINICAL LEVEL OF THYROXIN WILL NOT APPEAR LIKE A CRETIN,BUT WILL HAVE POOR ACADEMIC PERFORMANCE&ALSO EXHIBIT EVIDENCE OF LOWERED MENTAL MOTOR MILESTONES
THE NEUROLOGICAL DEVELOPMENT IF HUMAN BRAIN GREATLY DEPENDS UPON THYROXIN HORMONE,IS AN ESTABLISHED FACT.THE DEVELOPING EMBRYO GETS ITS BLOOD SUPPLY,FROM MOTHER WHOSE THYROXIN LEVEL IN BLOOD SHOULD BE ADEQUATE THERE ARE MANY PREGNANT MOTHERS LIVING IN MANY VILLAGES,DRINK WATER WITH LESS IODINE, MAIN SOURCE OF WHICH IS WATER &SALT.AS A RESULT IF AN EMBRYO IS GROWING IN A BLOOD DEPRIVED OF IODINE WILL RESULT IN THE NEURAL TISSUE DEVELOPEMENT BEING QUALITATIVELY AFFECTED.UNLESS THE BLOOD LEVEL OF IODINE ARE MONITORED THRICE DURING PREGNANCY HYPOTHYROID STATE DEVELOPING BECOMES INEVITABLE.A BABY BELOW SUB CLINICAL LEVEL OF THYROXIN WILL NOT APPEAR LIKE A CRETIN,BUT WILL HAVE POOR ACADEMIC PERFORMANCE&ALSO EXHIBIT EVIDENCE OF LOWERED MENTAL MOTOR MILESTONES
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