A Peadiatrician's Perceptual Experience

OSTEOPOROSIS- SELF DIAGNOSIS

2011-05-04T21:13:00.000-07:00

OSTEOPOROSIS IS A CONDITION WHERE THERE IS LESS BONE MASS,LESS BONE DENSITY DUE TO LESS CALCIUM IONS IN THE BONE,RESULTING IN EARLY&SPONTANEOUS FRACTURES ESPECIALLY IN WOMEN AFTER MENOPUASAL AGE.MORE THAN 50%OF WOMEN IN THE AGE GROUP OF 60-70YRS SUFFER FROM THIS DISABILITY,ALL OVER THE WORLD 90%COME TO KNOW THIS ONLY AFTER SUSTAINING A FRACURE.
SELF DIAGNOSIS BEFORE A FRACTURE&WITHOUT AN X-RAY:
THE NAILS ARE BRITTLE ,&BREAK EASILY,SPECIALLY IN THE TOE NAILS,WHICH PEEL EASILY,LIKE ONION SKIN.THEY ARE SOFT LIKE A PIECE OF SOFT CLOTH. THIS IS A THAT A FRACTURE SPINE IS INEVITABLR IN THE NEAR FUTURE.NOW THE PATIENT SHOULD TAKE A SUITALPREMONITARY SIGN.NOW THE PATIENT SHOULD TAKE A WLL QUAKIFIED DOCTOR"S ADVICE.

APLAIN XRAY CAN CONFIRM THE DIAGNOSIS

AUTISM-SPECTRUM DISORDER ( A .D .H .D)

2011-03-04T09:21:00.000-08:00

This is a psycho social disorder found in few children in the age group of2-5 years.
This a mental condition in which child finds difficulty in ,making any kind of communication by any or many of the five special senses,or unable to socialise or establish any kind of relationship with other people easily.
It is said that very big intellectuals/celebrities,like Eienstien,Bill gates suffered from autism during their infancy.This is fully crrectable ,provided ,it is recognised early &appropriate environemental stimulation given at early age itself.
This is also known as attention deficit hyper active disease.

chief charecteristic features of identification of this disorder:

1) unsatisfactory social interaction

2)unsatisfactory ,visual,verbal auditory communication.

3)show of disinterest on anything sourounding the child

OTHER MINOR POINTS OFTEN FOUND IN MAJORITY :

1)LESS ATTENTION TO SOCIAL STIMULI
2)LESS SMILE,/LESS LOOK AT OTHERS.
3)LESS EYE CONTACT
4)REPEATING WHAT OTHERS SAY
5)SENSORY ABNORMALITY-90%
6)POOR MUSCLE TONE-80%
7)TOE WALKING
8)MANTAL RETARDATION--MOSTLY
9)STRONG GENETIC BASIS.

AUTHER'S CONCEPTUAL THOUGHTS :

All the afore said clinical features are difficult to identify by non medical people.On the contrary it will be easier to identify that certain signs of intelligence are present or not &such signs keep increasing as they grow This intellectual improvement is continuous about a new "sign every week or atleast every month,once.IF A PARENT IS UNABLE TO identifysuch intelligent signs periodically ,then they should consult a senoir pediatritian or a child psychologist

The intellgence signs are present from age one month onwards & is a continuous Copying what elders do is a sign of intellgenceprocess.
What are the signs of intelligence(parents should ask the doctor)

Here are some examples:
At age one month :mother talks to new bornwhich listens carefully.After 1-3 minutes the baby makes1)bodily movements.2)babbles some sounds.3)hand movements obvious4)eye contact established with mother.5)looks at another person when interrupted atleast for a second.6)maks us know that its vision&hearing are good7)Obviously body language &sounds establish communication attempt without any doubt.If these are not found at age 3 months parents should consult an 'appropriate' doctorInnumerable signs of intelligence can be had from the auther by e-mail(drselvarajp@yahoo.com)

CONCLUSION&SUMMARY:
All babies are not born with adequate intelligence.At least 2-5 %childrn have sub standard intelligence,&they need to be identified early.parents must be vigilant to look for intellgence signs periodically from age one month ,when such intelligence signs ,are invisible they should report to an experienced doctor who will catogorise wheather it is1)hypothyroid state,2)Hearing disorder,3)vision disorder,4)small/big headcircumference, 5)Downs syndrome,6)Autismspectrumdisorder7)behaviur disorder 8)sensory system disorder 9)congenital metabolic/aminoacid disorder--All will cause permanent &irrevocable B R A I N D A M A G E ..

TWIN BABIES --HOW TO TAKE CARE?

2011-02-19T23:50:00.000-08:00

The following principles are applicable for triplets/quadriplets also.

Main principles;

beware of1)infection 2)aspiration 3)sids(sudden infant death syndrome)

prevention of infection: 1)use of mask on face by all elders.2)hand washing with antiseptics 3)fumigation of room (modified method)4)restrictd or absolute prevention
of outsiders/friends to enter baby room. 5)barrier nursing 6)nursing mother's hygiene/sanitation.

First 30 days are very important.brest milk contains cholostrum&it is a must for first week.It specifically prevents a neonatal diarrhoel disorder.
some pediatricians ,intra muscular human immunoglobulins on an empirical basis,
once a week for 6weeks in low birth weight babies if they are precious babies.
use of steroidinjection to mother can prevent possible lung immaturity.All said &done ,well trained pediatricians should be present for neonatal resucitation procedure.A good luxurious cry is a must&is the sign -quo-non against a possible
mental retardation.
5)warmth:maintanace of body emperature above normal is important There will not be any weight gain if there is any hypothermia.so room temperature maintanance is essential.
6)good nutrition vitamin ,minerals +iron are necessary.
7) neonatal screening test is necessary,specially thyroid status(T3 T4 TSH)THIS ESSENTIALLY TELLS UPON THE BABY'S INTELLIGENCE.
8)Any body coughing is not to be allowed into baby's room,as the main problem that can develope is respiratory infection.
9)modified fumigation of baby 's room
10) uMBILLICAL STUMP DRESSING .COMMENEST ROUTE OF ENTRY OF MICROORGANISMS .Absolute aseptic precaution for dressing umbillical cord stump till it falls down &even for one week later.Never touch stump with bare hands.Use gloves.
11)Betadine is best all purpose antiseptic.
12)never be hurry fora baby bath.sponge bath is sufficient.

BOTTLE STERILISATION;Unstrile practice will lead to diarrheal disorders,besides sugar intolerance /cow's milk intolerance ,breast milk intolerance (galectose intolerance) -all may contribute or agravate ehisting diarrhoea.Hence soya been milk is the preferred alternative ,in such state..Redness in the buttocks /anal region is the hall mark of sugar intolerance.
Not more than two people should handle babies.They should wear apron /over coats.

ASPIRATION :Single most common dangerous enemy to babies.It is nothing but milk getting into the respiratory tract,due to faulty feeding technique.causing severe cough ,respiratory distress.Prevention is stressed.treatment is done only in hospital,by a suction machine/broncoscopic aspiration

perfumes:Avoid all perfumes as it may cause allergic bronchiolitis leading to respiratory distress, /vomitingsleading to aspiration

Aggressive Medical Treatment

2011-02-16T20:01:00.000-08:00

AGGRESSIVE MEDICAL TREATMENT

Introduction :
Sometimes when a patient is very serious, conventional Text book treatment may not help. The medical ethics & scientific / statistical data often forces a physician to treat a patient as per therapeutic text book guidelines otherwise he is liable for a penal action for violating medico legal restrictions.

Definition :
No Text Book in medical literature gives precise method of treatment for any serious case. Then what constitutes an aggressive treatment. Text book of pediatrics (world renouned) by Waldoo Nelson says “any case which is very serious, should be subjected to aggressive medical treatment” no example of such aggressive treatment is available in any world medical literature.

Then how does a physician go about?
Hence an attempt is made to explore what is a serious case & what is aggressive treatments & how to identify, and what medical / surgical treatment would be best to revive that patient. All the case history examples given here, were treated by this author.

Actually, all the quoted cases need ICU like Treatment, but ICU facility is not available even in major District level hospitals. Hence the suggested modality of treatment.

Which is a serious case? Serious, very serious & extremely serious case depends upon the various clinical parameters which is one very abnormal from the normal.

Guide lines for assessment of a serious case.
Prognosis OK Bad Worse Worst
Parameters Normal Serious Very Serious Extremely serious
Consciousness Conscious Unconscious No response
to stlimuli Unconscious pupils slightly reacting to light
H R 80-120 120-200 > 200 fibrillation 400
R R 20-40 40-60 60-80
Acidotic Over 80
- same
Temp. 98.6
< 94
>104 < 90 cold
> 106 < 8006 ice cold
Other Physical Signs/ Symptoms
Fits No fits Continuous Status Epileptics Decerebrate spasm
Vomit No vomit Continuous
vomiting Haemetmesis Emesis + Acidotic breathing
Abd
Dis Nil Mild-moderate Mod-severe + Dyspnoea +
Tachypnoea All 3
Chest pain Nil Resostrernal Pain +
sweatings Pain + sweat +vomit + arrythmia
BP 130/80 Systolic 80
Diosystolic 60
Sys – 180
Dias – 100
Sys 60
Diast 0
Syst 200
Diasb 120
140 No BP
Recordable brady cond hypothermia.
Hydration Normal 5-10%
Dehydration 10-15%
Dehydration > 15% not revivable
Miclim “ Oliguria Anuria Anuria
Bun “ 50%
Increase 75%
Increase 100%
increase
Requires
Dialysis Requires
dialysis
Pulse oxymet 100% 80-90% 60-80% < 60 %

ECG Hh N Hh 60 40-60
40

Aim: When the physician is confronted with a very bad case, there are two options before him.
1. Treat the patient with drugs in the prescribed dosage, when the physician knows the outcome is likely to be poor & the progress is extremely bad, he may choose the second option.
2. Treat patient in the drugs which could be 4-8 times more than normal pharmacological level. This is most likely to yield a better result when the physician in his experience already knows the outcome with conventional dose.
3. Many experienced physicians (over 20-30 yrs service) can objectively & subjecting make assessment of a bad case as one that is not likely to survive even with best medical treatment.
4. When confronted with such a case, what is the harm in treating with a different way that may carry at least 5% chance for a survival? After all the treatment is absolutely scientific. Many bad cases are refused to be seen & ref. to government hospitals where the patients ultimately succumbs to his illness, or dies on the way to hospital & physicians refer such cases knowing fully well that the patient will die. How many physicians are there in the world to take up such cases as a challenge, and try to do their best, after informing the possible prognosis to the patients attender and also after getting his signature in an “informed consent paper.”

Meningo coccus attacks moninges & brain. But all the body organs are also affected as there is inter connection. When there is bacteremia / septicemia viraemia, then all body organs are simultaneously targeted when it is known as multi – organ failure syndrome (MOFS) where mortality rate is highest. So when there is a clinical / lab evidence of MOFS, why not a non conventional therapy instituted which may carry at least 5-10% good progress?

Here are some of the challenging type of cases treated by this author using the principle of Aggressive Medical treatment.

1. A 17 Years old boy sustained high voltage electric shock. (owning an electrical goods shop). Had status epileptics plus, decerebrate spasm. He was treatd with (1) Diazapam 20 mg Iv bolus + 20 mg in IV drip (2) Lasix 20 ml IV bolus 10 ml in drip (3) Dexamethprone 16 mg IV bolus + 16 mg in 20% glucose 200 ml IV drip. Ref to CMC Hospital 200 km away. The boy woke-up after 3 Hours asking for “Masala Dosai” a favourite eatable. The CMC doctors said, there is no need for further treatment. The boy is alive at Thiruvannamalai Tamil Nadu even this day.

2. An adult bitten by a poisonous cobra was treated by anti snake venom seerum. He was in coma for 3 days therefore he was given a blood transfusion donated by a snake-charmer who was bitten by poisonous snakes many number of times. Reason for such a selection of blood donar was that his blood was prescribed as it contain specific gama globlns against snake-venom and this immunoglobulin did he trick. He became conscious on day 5 & discharged on day 10.

3. 3 days old neonate stung by scorpion. Body was literally ice cold. Heart rate – could not be counted as it was so rapid (should be around 300 / mt.Lytic cock tail therapy started with spahenus venesection. Drug dosage was doubled & duration treatment doubled (4 days) steroid & diuretic were also added to exert an anticon vulsant anticerebral edema measures) & thwart – an acute renal failure. Discharged fit on day 7. Neonate had peripheral circulatory failure & treated by digoxin till heart rate came down to 140 / mt.
4. Diarrhoeal dehydration mortality in Children Hospital Egmore, Chennai, due to dehydration; is 15% aggressive - redehydration can bring about increased survival & reduced mortality rate. Author has treated 24 such cases & were successful. Method employed is double vaneseation done in all cases and fluid calculated at 400 ml / kg in 15% dehydration + acidosis + Hypo electrolytaemia. 100 ml / kg iv. Pushed very slowly for first 4 hrs. then 200 ml / kg IV pushed in the next 8 hrs. remaining 100 ml / kg allowed to drip slowly at 60 drops / mt. A dose of Lasix + Dexamethasone given to prevent pulmonary edema (6 cases out of 30 died of pulmonary / cerebral edema & is presumed to be due to sepsis & multi organ failure syndrome.

5. Generalised cyanosis in a normal new born. A new born baby suddenly developed cyanosis which was starting from periphery from all 4 links to abdomen thorax & then face. Cause could not be assessed by pediatrician, pediatric surgeon & Anesthetist (intensive case). Dexa methasone was given 3 doses within 1 hour & then Belamethesone inhaler was delivered into the lungs by a special technique through tube & chest compulsion. Baby became pink within 30 mts. Thereafter steroid was stopped in a tapering dose but baby developed bleeding though mouth & nose. A blood transmission was simultaneously given to arrest to bleeding. Baby became normal on day 3. The culprit was parents who administered thualsi-water from temple & that the baby got aspirated.

6. Poison ingerion – 20 year old boy. He took tab gradinal 60 mg, hargatil 50 mg & phenergan 25 mg – each 60 tables – total 180 tables at about 10 pm & attempted to commit suicide. He was seen at 8 a.m. next day when he was fully unconscious – comatose. No stomach wash given as it was too late (pupils dilated HR 60 mt RR 20 / mt). He was given (1) IV drip continues Isolyte P 6 bottles 24 hrs. (2) Inj Lasix 1000 mg IV bolus & 100 mg IV drip 12 X Hly. Bladder cathetrised periodically. Became conscious after 48 Hrs. & 50% dose given on day 3 discharged fit on day 5 when he could pass urine as before. Bladder control returned after 3 days. (3) Dexmethasone 16 mg IV bolus 16 mg IV drip for 4 days to prevent or relieve cerebral edema.

Diuresis & anticerebral edema measures alone were tried & is alive today.

7. Resuscitation of a just dead child. 1 year old injection penicillin given at TI cyeles India Arakonam, child cried & stopped breathing once for all. O/E no heart No respiration. Pupils dilated muscle tone – reflexes nil Inj adrenaline, Adsenalius & dexa & Deriphyllin & vensection for IV line. ET tube put & breathing attempted by blowing air like mouth to mouth, continues positive pressure ventilation – improvised method attempted. Child saved & is alive today child was brought by a lady doctor plastic surgeon from ticyeles to GH Arakonam – year 1977.

8. Neonatal Tetanus
Apart from many supportive treatment requirement, anti convulsant dosage above discussed. Venesection for IV line & Diaza pam 200 mg in IV drip. Initial rate 60 / dnps / mt . Later when convulsion is under controle dose reduced to 20 drops / mt. During recurrence of fits drip rae raised to 60/ mt.

In Dexametharone 0.5 mg Qid for 1 week & later tapered & stopped to prevent dextral edema.
The diazepam drug regimen was continued from 5-10 days & drug dosage reduced as pev clinical improvement.

2-3 small blood transfusion given (1) to supply in immunoglobulin (2) nutrition.

Milk was not given for 2 weeks for fear of aspiration.
Partial parenteral nutrition + blood transfusion helped to maintain nutritional status.

Author is not vouching that this is the correct treatment for these cases. But it is different from conventional drug – dosage practice in vogue.

The lesson learnt by the author is that when a case is dangerously ill & felt to be unlikely to survive the insult, very bold steps to be used with more drugs, higher dosage, of course very cautiously with masterly expectancy is required to produce better clinically rewarding results.

SWINE-FLU A(H1N1) PREVENTION-NEW RECOMMENDATIONS

2010-10-03T19:56:00.000-07:00

SWINE FLU--TIPS FOR PREVENTION:
-----------------------------------------
1)Steam inhalation,after exposure.
2)Inhalation -2 hrly-four times daily.
3)Instantaneous relief of nasal irritation, post nasal drip,naso pharingeal irritability,internal ear-pain,irritability,blood stained mucus on spitting can be felt.But death of virus can not be expected in a day.symptoms persist till inflamation subsides.
4)continuous steam inhalation necessary for a week..
5)can offer better protection than vaccine

WHAT IS AN EXPOSURE?
---------------------------
1) An absolutely normal person developing sneezing ,throat,tosil,or nasopharyngeal pain after
entering into a crowded place or staying in an ac car with closed windows ,when one of the passenger is coughing or sneezing.symptoms start in2-6 hrs.
2)A suspected, infected person sneezes coughs in side a public escalater/lift
3)visiting a big shop,when floor is broomed.people with dust allergy,visiting such places.
4)hospital workers should protect with mask.

All this can not be proven as no scientific study was done.bUT ALL THE ABOVE ARE THEORITICALLY ACCEPTABLE,as viruses can no longer survive in steam exposure repeatedly.

THE PROOF OF THE PUDDING IS IN THE EATING.

NEW BORN BABY INTELLIGENCE-ALL ABOUT IT

2010-08-28T22:24:00.000-07:00

INTRODUCTION:
A NEW BORN BAY' INTELLIGENCE DEPENDS UPON ITS INHERENT ABILITIES,&MANY OTHER EXTERNAL INFLUENCING FACTORS..ANY OR MANY OF THE FOLLOWING FACTORS MAY INTERFERE WITH THE THE BRAIN DEVELOPMENT &ITS INTELLIGENCE.
1)GENETIC MAKE UP
2)GOOD APGAR SCORE AT BIRTH.
3)INTRACRANIAL HEMORRHAGE.
4)CORD AROUND THE NECK PRIOR TO DELIVERY.
5)FETAL DISTRESS.
6)GOOD HEAD CIRCUMFERENCE AT BIRTH.
7)NO MATERNAL ANEMIA/HYPERTENSION/ MALNUTRITION.
8)GOOD VISION AT BIRTH.
9)GOOD HEARING CAPABILITY AT BIRTH.
10)EXTREMELY GOOD CRY AT BIRTH
(OPENS THE PATENCY OF ALL BRAIN BLOOD VESSELS)
11)GOOD THYROID STATUS (EU THYROID) IN MOTHER &BABY.
12)ENVIRONMENTAL STIMULATION-A CONTINUOUS PROCESS.

G E NE T I C M A K E U P
---------------------------
GENES ARE ULTRA(ELECTRON )MICROSCOPIC STRUCTURES.WHICH CARRY &PROPAGATE THE INTELLECTUAL CAPABILITY,OF ONE GENERATION TO ANOTHER GENERATION ALONG WITH MANY OTHER QUALITIES GOOD OR BAD ABOUT THE INDIVIDUALS CONCERNED.EDUCATION &INTELLIGENCE ARE NOT THE SAME .
AN EDUCATED PERSON NEED NOT BE INTELLIGENT&VICE VERSA.BUT EDUCATION DOES INCREASE THE INTELLECTUAL LEVEL.MANY UNEDUCATED MAY BE MORE INTELLIGENT THAN THE EDUCATED SO THE INTELLECTUAL TRAIT IS CARRIED FROM ONE GENERATION TO ANOTHER &OFTEN REFLECTED IN A CUMULATIVE MANNER,THROUGH THE GENES,CARRYING
TO POSITIVE PRINT IN THE NEXT GENERATION.TECHNICALLY THEY ARE REFERRED AS RNA,&DNA.THE FIRST GENERATION INDIVIDUAL MAY BE INTELLIGENT IN ONE WALK OF LIFE THE SECOND GENERATION COULD BE INTELLIGENT IN ANOTHER FIELD.THE THIRD GENERATION WILL HAVE INTELLIGENCE OF ITS OWN PLUS THE PREVIOUS TWO GENERATIONS INTELLIGENCE.THIS IS HOW THE INTELLIGENCE TREE KEEPS GROWING.

G O O D A P GA R S C O R E A T B I R T H.
----------------------------------------------
THIS MEANS THE CRY, COLOUR, ACTIVITY,REFLEXES,HEART RATE RESPIRATORY RATE ARE NORMAL WITHIN 10 Mts OF BIRTH&THAT THERE IS NO ASPHYXIA WHICH MEANS1)THE BRAIN BLOOD VESSELS ARE NOT PATENT ,OR NOT FULLY OPEN ,2)THERE IS NO ENOUGH OXYGEN SUPPLY TO THE BRAIN CELLS,3)THERE IS POOR GAS EXCHANGE IN THE LUNGS,WHICH MIGHT NOT HAVE EXPANDED FULLY.ULTIMATELY O2 SUPPLY TO BRAIN DECIDES THE NUMBER OF NEURONAL CELLS TO BE ACTIVE OR INACTIVE THE INACTIVE CELLS IF NOT PROPERLY OXYGENATED WITHIN 10-20 Mts WILL DIE & BECOME A SCAR THAT WILL LEAD ON TO THE DEVELOPMENT OF A CEREBRAL PALSY,LEADING TO MENTAL RETARDATION.

CEREBRAL PALSY MEANS ,PARALYSIS, OR MALFUNCTION,&PARTIAL OR TOTAL LOSS OF FUNCTION OF NEURONS AT CEREBRUM TO LACK OF BLOOD SUPPLY LEADING TO INSUFFICIENT OXYGEN ,TO NEURONS LEADING TO AN ALTERATION OF MUSCLE TONE&LOSS OF INTELLECTUAL FUNCTION LEADING TO,MENTAL RETARDATION OF VARIABLE DEGREES FROM POOR ACADEMIC PERFORMANCE TO TOTAL IDIOCY,OFTEN WITH INCREASED SPASTICITY OF ALL MUSCLES(ALSO KNOWN AS LITTLE'S DISEASE)(LITTLE WAS AN OUTSTANDING ORTHOPEDIC SURGEON IN THE WHOLE OF EUROPE WHO DISCOVERED THAT CEREBRAL PALSY IS DUE TO ASPHYXIA NEONATORUM &NOT PRIMARILY AN ORTHO CONDITION--THANKS TO DR LITTLE WHOSE OBSERVATION WAS BETTER THAN AN OBSTETRICIAN OF YESTER YEARS.

INTRA CRANIAL HAEMORRHAGE:
MANY NEW BORN BABIES SUFFER FROM THIS DISORDER, MAINLY DUE TOA A DEFICIENCY IN THE COAGULATION MECHANISM(FACTOR DEFICIENCY),AND THIS IS DUE TO A GENETIC DISORDER.THE HEMORRHAGE AGAIN IS VARIABLE AS PER THE QUANTITY OF THE DEFECT.INTRAVENTRICULAR HEMORRHAGE IS THE SEVEREST OF ALL,PRODUCING VERY MANY CNS COMPLICATIONS,SUCH AS FITS,SPASTICITY OF MUSCLES ,PARALYSIS,INTELLECTUAL DEFECT OF VARIABLE DEGREES.

FETAL DISTRESS:

OCCURS DURING ANTIPARTUM OR AT INTRAPARTUM PERIOD.SEVERE FETAL DISTRESS LEADS TO RESPIRATORY OR METABOLIC ACIDOSIS.CAN OCCUR IN THE FOLLOWING CONDITIONS:

1)INTRUTERINE GROWTH RETARDATION.
2)POST DATED GESTATION.
3)MATERNAL DIABETES MELLITUS
4)RHESUS SENSITISED PREGNANCY.
5)PREVIOUS H/O OF STILL BIRTH.
6)MATERNAL HYPERTENSION
7)FETAL HYPOXIA.
8)MATERNAL FEVER.
9)MATERNAL HYPERTHYROIDISM
10)FETAL ANEMIA, ARRHYTHMIA
11)PLACENTAL TRANSFER OF DRUGS
12)SLEEP STATE
13)PREMATURITY.

ALL THE ABOVE LEAD TO LESS BLOOD SUPPLY TO BRAIN RESULTING IN LESS OXYGEN SUPPLY TO CEREBRAL NEURONS THAT CAN JEOPARDISE THE INTELLECTUAL DEVELOPMENT

GOOD HEAD CIRCUMFERENCE AT BIRTH
---------------------------------------------
A BABY SHOULD HAVE AT LEAST 35 CM OF HEAD CIRCUMFERENCE.AT BIRTH.
1-2 CM LESS OR MORE ,MAY BE CONSIDERED AS VARIATIONS.ANYTHING LESSER MAY MEAN MICROCEPHALY &ANYTHING MORE MAY MEAN HYDROCEPHALUS, & NEEDS SERIAL MEASUREMENT FOR ASSESSMENT.&BOTH WILL AFFECT THE INTELLIGENCE GROSSLY.IN MICROCEPHALY IT IS NON DEVELOPEMENT,&IN HYDROCEPHALUS IT IS NEURONAL CELL DESTRUCTION BY THE SURROUNDING CSF PRESSURE THUS THE INTELLIGENCE DEVELOPMENT IS AFFECTED EVEN AT FOUNDATION LEVEL OF THE FUTURE CONSTRUCTION.

MATERNAL ANAEMIA/HYPERTENSION'S/MALNUTRITION.
MATERNAL ANAEMIA WILL LEAD TO FETAL ANAEMIA RESULTING IN POOR DELIVERY OF OXYGEN TO DEVELOPING NEURONAL CELLS THROUGH HEMOGLOBIN.AN ANOXIC CELL IS A WEEK CELL.HYPERTENSION WILL LEAD TO EXESS BLOOD FLOW&HEMORRHAGIC TENDENCY RESULTING IN CELL DEATH. MALNUTRITION WILL AFFECT CELL ANABOLISM AS PROTIEN IS NECESSARY FOR CONSTRUCTION&CARBOHYDRATE FOR FUEL.ALL THESE CONTRIBUTE FOR A POOR QUALITY NEURONAL CELL GROWTH &DEVELOPMENT OF INTELLIGENCE IS VERY DIFFICULT IN SUCH A DAMAGED CELL.

GOOD VISION AT BIRTH.
----------------------------
EYE IS SAID TO BE THE WINDOW OF THE BRAIN.MOST OF THE INFORMATION ENTERS INTO THE BRAIN VISUALLY&IS STORED LIKE A COMPUTER CHIP.INTELLIGENCE IS NOTHING BUT A COLLECTION OF INFORMATION,STORED, &RE UTILISATION OF THESE INFORMATION WHEN NECESSARY. OF THE NATURES FIVE GIFTED SPECIAL SENSES ,VISION IS BY FOR THE BEST.CHILDREN ARE GIVEN AUDIO VISUAL STIMULI TO IMPROVE THE INTELLECTUAL CAPACITY,DURING THEIR ATTEMPT TO LEARN.VARIOUS CONGENITAL EYE DEFECT MAY CONTRIBUTE DEFECTIVE VISION,LEADING TO INTERFERENCE WITH INTELLIGENCE FORMATION Eg :CONGENITAL CATARACT IN RUBELLA SYNDROME.

GOOD HEARING CAPABILITY :
WHEN DOES A NEWBORN START HEARING? WHEN CAN IT START SEEING?
BOTH ARE PRESENT AT BIRTH.IN FACT CAN HEAR &APPRECIATE SOUND WHEN IT IS IN UTERO WHEN A PREGNANT MOTHER SINGS THE BABY IS SUBJECTED TO THE VIBRATION TRANSMITTED THROUGH THE AMNIOTIC FLUID&THUS GETS USED TO SOUND APPRECIATION,UNLESS THERE IS A NEUROLOGICAL DEFICIT,OR A HYPOTHYROID STATE, AS SOON AS THE BABY IS BORN IT CAN OPEN THE EYES &SEE THE SURROUNDINGS AS IT WAS IN A DARK WORLD FOR NINE MONTHS&APPRECIATE THE PHOTIC STIMULATION OF THE EXTERNAL WORLD.BERA IS THE LATEST SOPHISTICATED TEST TO FIND OUT IF A BABY IS DEAF,THE TEST FINDS OUT IF THE SOUND WEAVES REACH THE BRAINCELLS.
USUALLY AT AGE 30 DAYS A NEW BORN BABY IS ABLE TO 1)VISUALISE AN OBJECT&FIX THAT OBJECT2)OR VISUALISE A SPOT FROM WHERE A SOUND IS COMING.3)IT CAN EVEN COMMUNICATE WITH AN OBJECT WHICH IS MAKING/CREATING A SOUND BY MAKING THROTY SYLLABLES .IF ALL THE THREE ABOVE FINDINGS ARE NOT PRESENT UPTO 90 DAYS A PEDIATRICIAN SHOULD SEE THE BABY.

EXTREMELY GOOD CRY AT BIRTH:
IT IS A SENSIBLE PRESUMPTION THAT IF A BABY CRIES VERY LOUDLY FOR A PROLONGED PERIOD &IF REPEATEDLY KEEPS CRYING THERE IS A THEORETICAL POINT THAT ALL BLOOD VESSELS IN THE BRAIN OPENS &BLOOD SUPPLY TO NEURONES MADE EASY. AT BIRTH ALLTUBES/DUCTS/VESSELS ARE NOT PATENT.SO THE ESTABLISHMENT OF PATENCY OF ALL BRAIN BLOOD VESSELS IMPERATIVE FOR ITS ULTIMATE INTELLECTUAL CAPABILITY DUE TO BETTER BLOOD SUPPLY THAT YIELDS BETTER OXYGEN WHICH IS THE MAIN FOOD FOR ALL CELLS ,SPECIALLY THE NERVE CELLS.

SO WE CAN PRESUME THAT A BABY AT BIRTH CRYING LOUDLY AT BIRTH IS DIFFERENT FROM A BABY NOT CRYING MUCH. THIS OF COURSE CAN BE PROOVED BY A RETROSPECTIVE STUDY.THE MORE LOUD THE BABY CRIES ,MORE PINK THE COLOUR WILL BE INDICATIVE OF BETTER LUNG FUNCTION/EXPANSION,BETTER OXYGEN CO2 DISSOCIATION, BETTER BLOOD SUPPLY TO ALL ORGANS OF BODY,INCLUDING BRAIN.IF THE OPPOSITE BEFALLS ,DEVELOPEMENT OF MENTAL RETARDATION IS A STRONG POSSIBILITY..

CORD ROUND THE NECK:
---------------------------
ABOUT 5-10% OF BABIES NECK GET ENTANGLED IN THE UMBILLICAL CORD WHILE FLOATING IN THE AMNIOTIC FLUID INSIDE THE SACK.SOMETIMES IT MAY LEAD TO A STRANGULATING EFFECT CAUSING FETAL DISTRESS SPECIALLY WHEN THE CORD GOES TWICE OR THRICE AROUND NECK..THIS CAN LITERALLY CAUSE ASPHYXIATION
IN UTERO OR PERINATALLY WHEN COMES OUT PER VIA NATURALIS.DEPENDING ON THE TIGHTNESS OF THE CORD AROUND THE NECK THE OUTCOME IS ALSO VARIABLE.MOST SUCH BABIES ARE BORN WITH VERY LOW OR ZERO APGAR SCORE WHEN IT BECOMES A CHALLANGING TASK FOR THE NEONATOLOGIST TO REVIVE &
RESUCITATE THE BABY. ONLY AN EXPERIENCED PERSON ALONE CAN SUCCESSFULLY RESUCITATE SUCH BABIES TO 100%

GOOD THYROID STATUS IN MOTHER &BABY
----------------------------------------------------
THYROID IS A DUCTLESS GLAND PRODUING THYROXIN A HORMONE INTRICATELLY INTEGRATED WITH INTELLIGENCE.NO THYROID MEANS NO INTELLIGENCE .ALSO IT HAS INFLUENCE OVER ALL THE BODY TISSUES. ITS ABSENCE WILL SELECTIVELY CAUSE BRAIN &BONE DAMAGE IN THE FORMATIVE YEARS.THYROID DIFFICIENCY CAN BE CLINICALLY DIAGNOSED IN 3-6 MONTHS AGE GROUP BABIES.&IS FULLY RECTIFIABLE BY CONTINUOUS THYROID TREATMENT.

Rh-INCOMPATIBILITY.
--------------------------
IF MOTHER IS Rh NEGATIVE, &FOETUS Rh POSITIVE,ABOUT 2-10 % BABIES CAN DEVELOP BLOOD GROUP INCOMPATIBILITY, LEADING TO RBC DESTRUCTION, &CONSEQUENT IRRVERSIBLE BRAIN DAMAGE WITH JAUNDICE ,MUSCLE SPASM, FITS, &MENTAL RETARDATION.

ENVIRONEMENTAL STIMULATION:MOST IMPORTANT CONTINUOUS PROCESS.
------------------------------------------------------------------------------------------
A CHILD'S BRAIN DEVELOPEMENT DEPENDS ON THE FOLLOWING GROSS FACTORS APART FRI=OM THE AFORESAID CAUSES.:-
1)BRAIN MASS MUST GROW &THE SKULL BONES MUST ALLOW THIS ENLARGEMENT/EXPANSION &ACCOMODATE BIGGER MASS BY SUITABLY INCREASING THE INNER SKULL SPACE.
2)THE VARIOUS NUTRITION FACTORS &THYROXIN HELP INTHE BRAIN MASS INCREASE.
3)BY APPROPRIATE STIMULATION OF ALL FIVE SPECIAL SENSES THE CORTICAL NEURONES STORE THE INFORMATIONS RECIEVED FROM TIME TO TIME IN THE FORM OF A' FUNCTIONAL' LAYER ,COMPARABLE TO A COMPUETOR CHIP.THE STIMULI RECIEVED KEEP INCREASING IN NUMBER &QUALITY AS TIME PROGRESSES. BEFORE LEARNING WORDS &SENTENCES BABY LEARNS THE SYLLABLES,LIKE A B C ,WITH PHONATION,THIS SYSTEMATIC WAY OF LEARNING IS A MUST TO SHOW GROWTH &PROGRESS.

STORY OF WOLF RAMAN
---------------------------
THIS IS A TRUE STORY OCCURED AT VELLORE-TAMILNADU-INDIA.
PUBLISHED ALL OVER THE WORLD IN ALL NEWSPAPERS 50 YEARS BACK.
A CHILD AGED ABOUT 5 WAS FOUND MAKING NOICE &JUMPING LIKE WOLF IN A JUNGLE SPOTTED BY FEW HUNTERS, WHO BROUGHT CHILD FROM JUNGLE TO CMC HOSPITAL.VARIOUS SPECIALITY DOCTORS FROM VARIOUS PARTS OF THE WORLD
POURED INTO CMC TO SEE &STUDY THE BABY.INTER NATIONAL SYMPOSIUM WERE CONDUCTED..EXCEPT FOR THE EXTERNAL FEATURES OF A HUMAN CHILD BOYHAD ALL THE CHARECTERS OF ANIMALS ONLY &DIED IN HOSPITAL IN ABOUT 2MONTHES PROBALY DUE TO ENVIRONMENTAL SEPERATION

DISCUSSION:
THIS CHILD MUST HAVE BEEN ABDUCTED FROM A VILLAGE BY A WOLF/FOX,OR MUST HAVE BEEN ABANDENED BY A MOTHER AFTER AN ILLEGITIMATE PREGNANCY.THIS CHILD NEVER HAD ANY STIMULATION FROM HUMANS AT ANY TIME..WHAT WAS STRICKINGLY OBVIOUS WAS IT POSSESSED ALL THE CHARECTERS OF ANIMAL&NOTHING FROM HUMANS..
THIS EXPLAINS HOW AN ENVIRONE MENT IS IMPORTANT IN SHAPING FOR ITS INTELLECTUAL STIMULATION,FOR ITS ULTIMATE BRAIN GROWTH QUQLITATIVELY EMOTIONALLY FOR ITS INTELLECTUAL OUTCOME.
----------------------------------------

2010-01-12T01:28:00.000-08:00

SRM Specialty Hospital
SRM University
Ramapuram – Chennai
Tamilnadu – India

Neonatal Resuscitation New Concept

STATISTICS

1.Asphyxia > 900000/- year W.H.O 2000-2003.
2.23% of Neonatal deaths are Asphyxia Lancet 2005
3.4 million Neonatal death – World wide.
4.Neonatal death 20% China – 2005 developed countries have protocols/programmes like CME.
5.CPincidence – 2 per 1000 population
6.Asphyxia – Mortality More than morbidity.
7.CP- Prevalance 4 per 1000 live births.
8.One – out of 4 ‘bad’ babies – CP

ASPHYXIA
1. What is Asphyxia literally?
2. Is it a misnomer here?
3. Is it a CNS depression due to
bio-chemical metabolic change?
4. Can we call all cyanosis as
asphyxia?
5. What is asphyxia Neonatorum?

Pertinent Questions-NRT
►What is it?
►Where is it done?
►How is it done?
►Who can do it?
►What are the required Equipments?
►What is Asphyxia Neonatorum?
►Is “Asphyxia” a right word here?
►What are the ill effects of failure of NR (Littles’ disease)
►Can we correct it to 100% if so how?

Good Old Dictum – ABC

What is A/B/C?
If no cry or respiration
a) Intubations by ET tube.
b) Oxygen by catheter / mask / hood
c) Ambu bag inflation / deflation.
d) Positive pressure ventilation.
e) Neonatal intensive care unit admission
Is it all necessary?
Does it yield the desired fruit?
If not why should we dothe same?
Why should not we change for better?

New Technique (Designed by author)

“Old Order changeth,
Yielding place to new”
PNEUMONICS : TTDS (Forget ABC)
•T : Thirupathi
•T : Thirumala
•D : Devasthanam
•S : Sanctorum

Further Expansion

T FOR TACTILE - EMBRACES
a. Tapping Baby’s back
b. Tapping Baby’s soles
c. Tapping Baby’s Toes
d. Squeezing Baby’s Ear Lobe with gauze
e. Pushing left index finger into baby’s left molar
f. Squeezing chest through Axillae
g. “Feel of Bite” Sense: Massester Muscle Tone.

T For Tracheal - Embraces

•NG Tube Stimulation through Nose / Mouth.
•NG Tube Stimulation at Tracheal opening.
•Tracheal Suction without ET Tube
•Aim 1. Stimulation by touch
2. Suction of Aspirated
Amniotic fluid, Meconium,
Vernix casseosa

D For Drugs - Embraces
Drug stimulation by following drugs.
a.Glucose 10 – 20 %
b.Soda Bicarb 7.5% 99%
c.Beclamathasone inhaler by Special tubing + Thoracic Squeezing in Rhythmic fashion – 0.75%
d.Adrenalin
e.Deriphylline
f.Dexamethasone – Inj – If necessary

TTDS – Success rate 100% - If
1.FH was present 5 minutes before delivery
2.No cord around the neck more than Twice.
3.No cardiac / Pulmonary / CNS / Tracheobronchial anatomical abnormality.
4.No Hiatus hernia.
5.No birth weight below 1200 gms
6.No RDS / Foetal aspiration syndrome / HMD.
7.No previous H/O foetal death
8.No Maternal diabetes / hypertension / drug withdrawal
9.No Spinal shock due to spinal anaestheria
10.No Apgar score at 0 in first 5 mts.
11.No “feel of bite” at any time during resuscitation .
12.No Placenta Previa

A. Resuscitation Team - Work Assignment

1. Baby receiving
2.Baby positioning – Neck rest – head down
3.Warmer light
4.Suction machine – On / off
5.Chest compression / Tactile Stimulation.

B. Time Keeper
1.Notes birth time
2.Announces every minute by counts.
3.Announces HR / RR - Every Minute
4.Pulse Oxymeter Reader every minute
5.Venesection instruments.
6.umbilical cathetrisation – IV drip.

C. Equipment Procurement
1.Soda Bicarb
2.25% Glucose
3.Deriphylline
4.Dexamethasone
5.Beclamethasone Inhaler
6.Laryngoscope
7.suction catheters / Sterile Hand gloves - Size
8.NG tube size 5,8
9.Butterfly needle – No. 24

10. 20 ml / 5ml syringe
11. Needle No. 26.
12. Vitamin K
13. Styptochrome
14. Calcium
15. Diazapam
16. Epsolin
D. Resuscitator / commander / Chief coordinator (Doctor)

Baby Crying Score (designed by author as per the cry duration in seconds / minutes)

n0 - No cry at Birth and at any time
n1- 3 Average cry (5-10 Sec after each stimulus)
n4- 6 Good cry (> than 15 sec after stimulus interruptedly for 2 hrs)
n7- 9 Very Good luxurious cry > 30 seconds after each stimulus for 6 hrs or more.

Score 5 & above – Excellent cry - brain blood vessels – open fully.
If no cry - asphyxia develops? (cyanosis)
Asphyxia – causes CP / MR / Low academic performances
Behaviour problem like ADHD

Trump card of Neonatal Resuscitation if there is substandard cry

§Tracheal Suction
§Thoracic Squeezing
§Correction of Hypoglycemia
§Correction of Acidosis
§If child cries immediately after NaHCo3 it means uncorrected metabolic acidosis - now corrected

Drug Dose

ØFirst Shot : NaHCo3 (5ml) + 10% Glucose (5 ml) intra umbilically
ØSecond shot : If there is no satisfactory cry repeat same after 5 minutes.
ØRepeat Every 5 minutes for 3-5 times according to necessity.

Aggressive Neonatal Resuscitation Indication

Born as if still birth.
Born with low Apgar Below 5 after 5 minutes
Obvious Cyanosis
No cry for 5 minutes after delivery.
Gross Hypotonicity generalized
HR < 60 / Minute
RR < 16 / Minute
Precious Child

Procedure

Continuous chest compression & Tracheal Suction
Beclamethosone inhalar through tube
NaHCo3 + 25% Glucose – Large dose
Umbilical Venous Cathetrization
Defibrillation – When all measures fail.

Author’s

►Professional Experience : 45 years
►Pure Pediatrics experience : 35 years
►100% success rate in NRT : 20 years

Thank You

neonatal resusitation technique-new concept

2010-01-12T01:24:00.000-08:00

CHILD PSYCHOLOGY FOR PARENTS.

2009-12-21T21:07:00.000-08:00

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.

NEWMUMS DOUBTS ABOUT HER NEW BORN-CLARIFIED

2009-12-17T23:29:00.000-08:00

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.

BABY-CRY-TREATMENT TIPS

2009-12-13T06:18:00.000-08:00

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.

BABY-CRY-60 CAUSES

2009-12-12T23:17:00.000-08:00

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.

DOUBTS OF NEW MUM NEW BORN RELATED

2009-12-12T07:30:00.000-08:00

---------------------------------------
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

UMBILLICAL HERNIA-NON SURGICAL TREATMENT

2009-12-01T23:23:00.000-08:00

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.

MEDICAL CONCEPT -UNPUBLISHED--3

2009-11-21T22:06:00.000-08:00

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.

FISH &CALCIUM TREATMENT.

2009-11-02T20:56:00.000-08:00

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

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

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

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

FISH &CALCIUM TREATMENT

2009-11-02T19:55:00.000-08:00

2009-10-26T02:06:00.001-07:00

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

2009-10-25T02:09:00.000-07:00

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

2009-09-28T04:24:00.000-07:00

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

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

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

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

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

SWINE FLU-A(H1N1) VIRUS VACCINE FEARS

2009-09-25T05:29:00.000-07:00

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

ASPHYXIA NEONATORUM

2009-08-08T23:04:00.000-07:00

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.

single visit/ONE JAB POLYIMMUNISATION

2009-02-01T19:29:00.000-08:00

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.

single visit/ONE JABpoly immunisation

2009-02-01T19:22:00.000-08:00

unpublished concepts in medicine

2009-01-30T19:07:00.000-08:00

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.

UNPUBLISHED MEDICAL CONCEPT--2

2009-01-01T05:52:00.000-08:00

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

ADHD-UNPUBLISHED CONCEPT

2008-12-30T06:24:00.000-08:00

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

2008-12-28T00:28:00.000-08:00

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

2008-11-26T21:16:00.000-08:00

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

2008-11-23T01:57:00.000-08:00

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

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:

Disease of the ear, nose throat:

Fourth editon, them ballentyne & Jhon Groves Bufferworths

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

Tips for practicing pediatricians

2008-11-21T21:31:00.000-08:00

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

2008-09-24T04:01:00.000-07:00

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.

2008-09-24T03:57:00.000-07:00

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

2008-09-20T23:33:00.000-07:00

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.

2008-09-18T23:14:00.002-07:00

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

2008-09-18T23:14:00.001-07:00

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

2008-06-30T22:36:00.000-07:00

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

2008-03-03T08:19:00.000-08:00

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

2008-02-24T07:34:00.000-08:00

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 .

2008-02-22T07:58:00.000-08:00

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.

2008-02-17T07:40:00.000-08:00

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

2008-02-16T08:06:00.000-08:00

"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.

ELOCUTION-GUIDE TO CHILDREN(PARENTS)

2008-02-15T05:35:00.000-08:00

Children should participate in extra curricular activities like elocution contests,as it will give them self confidence.&a subjective assessment of themselves, for a healthy psychological state. This is written with the hope that parents might take this hint to help their children.

They should guide children continuously & encourage them.Parents, teachers, or well wishers must be in charge as a coach at all times.The following points must be physically checked while preparing a child for a competition.

Must talk boldly. This is very important because if the child is scared before the audience he will forget what to speak. The best way to get rid of fear complex is, to tell him that all the spectators in front are fools &that the child alone is intelligent.BETTER the child is taught to look into a mirror &say within his "heart" in his private room thus:"All those in front of me are fools".So the child when gets on stage speakers like this mentally before opening the mouth for a talk.
Must have several rehearsals.
Body language essential as per contents of speech.
VOICE MUST BE AUDIBLE &LOUD.No harm if the volume of sound is more than average.Child can speak 2-3 sentences &ask the audience whether they can hear.Beware the mick may fail due to electricity failure.
contents of speech:For example if the subject is related to the topic"THE TRUTH",speak about Harichandra a Hindu mythological hero or if it is "SACRIFICE", PEOPLE WHO MADE THE HIGHEST SACRIFICE BY NAME IS ESSENTIAL,LIKE VEERAPANDIA KATTABOMMAN
VOC, OR NEHRU FAMILY,should be mentioned.The child who uses the name of the best & famous personalities who are known for heroism,or valor alone wins the contest.
Better not to see the paper while talking.But under certain circumstances can look into the points.
Better to mix some humor in the form of a short story for people to laugh,&clap hands.
Address the stage as RESPECTFUL TEACHERS,BROTHERS & SISTER
SOME GESTURES,TO START WITH, AS IF THIS STAGE IS NOTHING FOR YOU,BY RUBBING YOUR FACE NECK ears ON ONE SIDE&LOOKING UP
IF YOU FORGET BY CHANCE,THE NEXT POINT OF YOUR SPEECH,take out your hand kerchief & clean your face to recollect the forgotten point. not too fast. Let the audience hear each &every sentence of yours.
Add one or two quotations if possible.Books available for this purpose can be referred to.
RECORD THE SPEECH IN A TAPE RECORDER,&REPLAY.MAKE necessary corrections.
Can start with a relevant "Thirukkural", first,&translate it into English. Continue other points latter.
Have a high level of confidence.you will not miss points.
A coach is necessary,be it a teacher, or parent.
It should be stressed, that winning the prize is not the motto,but the spirit of participation is important,so that if the child does not win the contest ,he should not feel discouraged &loose his heart .This should be strongly advised before hand ,well in advance.
Some children may feel guilty as if they have made a big mistake.Tell them that failures are stepping stones to success.

MERCHANT OF VENICE FOR CHILDREN

2008-02-11T08:25:00.000-08:00

This is a short script for enactment of drama suitable for children around 12 yrs of age.To enact any shakespear's work a minimum of 3 hrs required.This is mainly written for children under 12 yrs.so only a selected scene ,considered as climax of the play is attempted here.& may last 15 mts on the stage.The word "ok ok"should be avoided by the actors as it was not in use in shakespear's era.Most of the sentences are in first person,like the usage in shakespear.Sentences made short for the sake of children.---AUTHER.
COMPERER SPEAKS OVER MICK:
LADIES &GENTLEMEN,,YOU ARE GOING TO WATCH A SHORT PLAY OF SHEKESPERE'S MERCHANT OF VENICE NOW BY CHILDREN.The acters are:mr x ----as antonio,etc etc.William shakespere was born on 23 april 1564,in Statford - upon-Avon in England.He wrote on all subjects of human behaviour,after keen observation of his sorroundings.All his literary works will live as long as earth is alive.To him we respectfully dedicate this drama.
MERCHANT OF VENICE.
SCENE -ONE
(Screen openswith a thunderous sound of a heavy water splashing& there is full darkness of the stage for 5 -7 seconds.This is only symbolic.The first film of merchant of venice in french started like this.)
charecter introduction:All charecters appear one by one &introduce themselves to the spectaters.
Shakespere:I am william shakespere.I am the auther of today's drama.I have written several tragedies &comedies.This is tragic-cum-comedy.There is a murder conspiracy by shylock.It ends up in comedy with portia &Bessanio joining together.
Antonio:I am Antonio,one of the richest merchant of venice.I have plenty of ships on the seas.
Bessanio is my bosom friend.I took loan from shylock to help my friend.
Bessanio:I am a frind of Antonio.I met a beautyful &rich lady portia whom Iwant to get married.As I dont have money I requested my friend ANTONIO to help me .
Shylock:I am a jew &money lender. I hate Antonio as he has insulted me on several accasions.
I am looking for opportunity to wreak vengence.
Portia:I am the daughter of a rich man from Venice.I am in love with Bessanio.I am going in diguise as a lawyer.I will argue in shylock's case in favour of Antonio.
Duke:Shylock's case is heared in my court.Iwill hear the arguements from both sides & give my judgement.

S C E N E -2
Bessanio: Oh Antonio, my bosom friend.I need your help.
Antonio:Oh! my friend tell me what can I do for you?
Bessanio:I love Portia,a rich &beautiful lady.I want to marry her.so I need money from you.
Antonio:Dont worry.I will help you.I have no money now. so I will borrow money from Shylock
on loan.

S C E N E--3. S h y l o c k ' s Place.
Shylock:Oh! Antonio,Oh! Bessanio,What do you want?
Antonio: I need money.3000 Ducats.
Shylock:I GIVE MONEY FOR INTEREST.But in your case,I will not take any interest.I write in the bond one pound of flesh from a part of your body nearest to your heart, just for fun, in case you dont return the money in 3 months.
Bessanio:Antonio,Dont sign.dont take the risk.
Antonio: Dont you worry.MY SHIPS WILL RETURN NEXT MONTH.We can return the money.

S C E N E --4
PLACE:DUKE'S COURT.

CLERK READS OUT:
Plaintiff :shylock.
Defendent:Antonio
Defendant's lawyer: Portia.

Duke:H
AS SHYLOCK COME HERE?
Sylock;YES YOUR GRACE.
DUKE : Tell me shylock.what is your case?
Shylock: ThyGrace.Now 3 months over since I gave money to Antonio.Since the time is expired ,he should give me a pound of flesh,as per bond,signed by Antonio.+3000 ducats.
Duke: Antonio what do you say?
Antonio:. My lawyer will speak for me.
Portia:(she bows &starts spreaking)
MY LORD Shylock is keen about a pound of flesh.(stops) Let him have it.Have you brought the balance Shylock?
Shylock;Yes I have.
Portia:You cut the flesh from the nearest part to the chest.Not more.Not less.
Shylock: That is not mentioned in the bond.
Portia:In that case there should be no blood shed,because it is also not mentioned in the bond.
MY LORD,is it possible to take flesh without blood shed?I dont want my cliant to loose even a single drop of blood.Shylock has conspired to murder Antonio,as one can not cut flesh without a bllod shed.
Duke;Now it is judgement time.
clerk:Silence ..Silence.
Duke:As the conspirasy is obvious Shylock has planned to murder Antonio.
Shylock, I ORDER YOU to apologise.You should give half of your fortune to the government & half to Anonio as punishment.
(Shylock walks of in shame.Antonio,Bessanio,&portia in gay mood.)

ARE YOU A SUPER DRIVER?

2008-02-03T14:51:00.000-08:00

WHO IS A SUPER DRIVER?
He is one ,who knows the ins &outsof driving thoroughly with a minimum arbitary record of ten years without even a minor accident or a scratch to vehicle&is one who has got exposure under various driving conditions with all physical psychological stress strain &who has a fair knowledge &exposure of the various points discussed below,with a sound & sharp presence of mind at any one given situation.
Driving is an art.It differs on accasions &methods adopted as per situations.To be a super driver atleast the following 60 points must be considered meticulously&must come out with flying colours in each point any time &every time.
1)Night driving:very dangerous &risky.speed is number one enemy.second SLEEPY MOOD.
2)day driving:Tiredness is important if heavy duty done in the previous night or in the afternoons in a hot weather.
3)congested area:must go slow as there will be lot of pedestrians,children playing in the streets.
4)peak hours:as there will be heavy rush &lot of disorderly drivings specially by motor cyclists
extra care has to be exercised.
5)small lanes:children from home will fall down into the road from nowhere,as if from the sky!.
6)school area :danger zone from 6am -6pm.
77)schooltime:12-1pm, 4-6pm are school closing hours.so beware children coming running.
8)high ways;Temptation to drive fast is irresistable.Though road is broad this is where accidents are more prone,causing danger to life..
9)during rain:really does not matter in city driving.But it matters in highways.skidding is common during first 30 minutes.visibility will be poor according to quantom.If it is night it will be much worse.
10)drizzling or cats &dogs?Both are dangerous.FOG LIGHTS OR EXTRA LIGHTS TO BE PUT ON.never exceed 40 km /hr speed.In heavy rain better to halt the vehicle.if there is lightning dont stop under a tall tree as the thunder stirke is possible.
11)slushy road:Tires may get struck.you may wait for a big vehicle to pass through&can follow that tyre marks.
12)skid prone road: If it is a new tar mac & the surface is very smooth &to add fuel to fire there may be some oil spill by advancing vehicle that can cause a skid.
13)heavy vehicles from opposite direction.
ordinary lorry--just dangerous.
state trans port buses--very dangerous.
water lorry--most dangerous,most ruthless.Atleast one death is caused by water lorry every day
14)accident prone times:EARLY MORNING 2-4 AM. MOST DRIVERS SLEEP DURING THIS TIME.THOSE WHO CAN NOT CONTROLE SLEEP CAN NOT CONTROLE VEHICLE.
15)HEAVILY LOADED LORRY COMING IN FRONT;USUALLY THESE LORRIES can not have good controle.They will come wobbling like a snake.
16)speed of vehicle from opposite direction:when your judge ment is that he is coming in 100km/hror more you better slow down or haltif there is some other moving object in the scene.
17)overtaking vehicles from opposite direction;when you see 2 vehicles side by side you better stop&watch with masterly expectancy.
18)Animals crossing:In India dogs bafallows cows bullocks crossing the road at their own turtle speed is a common sight:some times you stop or you may have to accelerate as the big animal choose to cross suddenly.if you apply breaks sometimes it may be disasterous.
19)curvy road:must slow down to less than 40/km.
20)drivers tiredness:one of the top 5 causes for car-crash.freshen yourself with a face wash,dont wipe for 5 mts so the face gets cooled.take a cup of tea/cigareettes if you are accustomed or put a chewing gum,listen to music(not in the moving car)
21)SLEEPY MOODS:This is top number one cause for FATAL accident
If you feel asleep,please think that is your last day or night&you are not going to see the next day for sure.if you dont think that way &still drive you are comitting a suicide.Dont keep a person next to you sleeping,because it may aggravate your sleep.God only can help under such situation,but He wont help such people.
22)Automatic eye lids closure:If eye lids close against your wish,that is a premonitary sign you are going to sleep&THAT SLEEP IS OVERTAKING YOU.stop the vehicle on your leftside.either freshen or sleep in the car atleast for 15 mts &start car later.23)Alcohol,sedative 12hrs after
may be acceptable.
24)overspeeding knowingly:many lorry drivers,bus drivershave wrong notion that if they overspeed during sleep,the sleep will get disturbed,thinking it will increase the alertness.
25)music while driving:certainly it will distract the driver's attention.
26)flight of thoughts:some people have the habit of day"dreaming" in a conscious state.,so the driver does not know where he is what he is doing,putting himself in a different world.THIS WILL END UP IN TOTAL CALAMITY.
27)rest for driver:no driving permitted for more than 4 hrs at a stretch,&driving continuoesly over 6-8 hrs not permissible.can drive only after 24 hrs.
28)opposite vehicle with glaring lights:reduce your speed.dont get annoyed with him &spoil your mood.for safe driving you should have good moods.
29)visibility distance:A minimum of 100 meters visibility is ideal, at all times.
30)Emotional out bursts:prior to starting the vehicle , or at any time while driving the vehicle,you should never enter into heated arguments ,or muttering yourself when another driver on the road exibits disorderly behaviour.
31)confidence level:never loose your confidence&never be too confident;vehicles involving accidents with trains at UNMANNED LEVEL CROSSINGS are due to sheer carelessness &too much confidence.stop,listen&proceed rule must be practiced here.
32)tyre condition;Between the two ribs there should be a minimum deapth of 2 mm(the lenth of the tip of the ball point pen ateast is mendatory.If it is bald it requires changing preferably to new tyre.Better tyre should be in the front allways.
33)rear view mirror:constant &vigilant watching of rear view ,&side mirrors are essential.Inboth side view mirrors a small tail portion of the vehicle should be seen after adjustment.see what is coming on your right before moving the vehicle
34)Break check:when you start the vehicle give trial check of the breaks,so if there is abreak failureyou dont realise it late.
35)Tyre pressure:keep a pressure gauge and check tyre pressure twice a week.
36)"Be cautious,be cautious",your mind must be alerting you at all times.
37)EYES &EARS MUST BE IN GOOD CONDITION.many profesional drivers have cataract eyes or moderate degree of deafness or colour blind.
38)Over taking:no over taking when advancing vehicle is going at speed of 60-80 km/hr
no overtaking in curvy roads congested road or if the road is not broad enough.
39)Overspeeding is necessary at crucial times.(suddenly &quiet unexpectedly a bullock cart turning when you are in good speed,in front or a speeding vehicle coming in front breaking the MEDIAN)
40)Presence of mind:At ANY ONE GIVEN SITUATION ,your mind must choose the best.(if there is a dog on the right & a man on the left,if you have to hit on, choose dog not the man.)
41)Lorry cleaners drive:Most lorry drivers when they feel sleepy allow the cleaners to drive.This can be assessed to some extant well in advance,The lorry willbe coming in good speed&in stagering gait as if "drunk".
42)Driving in full stomach.:You should never drive long distance in full stomach.You will feel sleepy because the blood sugar level goes up.
43)driving at 2--4 pm.As this is also the nap time &as the sleep is a condition reflex ,drowsiness &sleep are unavoidable,So be careful jut like 2-4 am timewhich is an accident prone time.
44)Those who are epileptic,who are on drugs should not drive within 2-6 hrs as that is the peak action time of the drug.Similarly pain killers or any new medicine used first time in ones life should betried only at home(one professional driver asked for a head ache pill-metasin,when an occupant took one for her head ache.within 2 hrs, he developed drug anaphylaxis--fatal drug reaction unless recognised quick &treated.He collapsed &was admitted in hospital where he recovered.)
45)Driving daily is like entering death well daily."Karanam thavarinal maranam"--Tamil proverb.If you slip in the somarslt gymnastic may fall down inside death well.So driving is comparable to this.
46)Proficiency of all these points must be attained before 30--35 when the confidence level &pysical stamina are high.
47)must have cool &calm temperament &not easily irritable.All those who get easily irritated will commit accident definitely.
48)police fine:Even a single bill from cops will disqualify you to be asuper driver.
49)Mountainous terrain driving:Roads here are narrow.lot of uphills &down hills.short distance visibility due to curvy roads.a)never go fast.b)if you climb an uphill in first gear,you must come down also in the same gear.while coming down adjust speed by gear changing than by breaks.
50)many accidents occur because people dont stop at RED LIGHTS.Better to stop in the yellow light itslf.
51)Adjust mirror,reduce blind spotbefore starting the vehicle.
52)Distractions:Visual, Psychological:Can be by other car occupant.Can be due to some vehicle accident ,or police stopping advancing vehicles or a big eye catching banner on the road.Adjusting
music control,cell phone use(even if it is hands free equipment).All these take the drivers mind off the road.
53)sun-shine glare:Avoid while proceeding east in the mornig&west in the evenings.Use the sunshade pade from the panel.use cooling glass for the eyes.
54)Turn on the head lights when you use your wipers.It will help increase your visibility &will help other drivers to see you.In many states in USA it is the law.
55)Keep car windows clear.
56)Wear the seat belts:In USA,every 15 secondssomeone is injured every 13 mts some one is killed.seat belt reduces severity of injuries/fatalities.Estimated to save 11000 lives each year.
57)Adjust &lock the head rest.
58)In emergency.keep foot on breaks& press hard.dont pump.keep pressing.
59)aggressive drivers with disorderly behaviour.If you see one on the road simply tell yourself"OH GOD forgive them. They know not what they are doing".Otherwise your driving will not be safe.
60)reverse driving:Allways practice slow reverse.Before taking a parked vehicle better to give a look physically.
Few actual true life vivid examples to keep in mind.
a) 35 yr old,(USA)drove from point A to point B at about 7.30 pm.He suddenly felt intense desire to sleep.The destination point is only 15 mts away.But he chose to stop the car at a near by lodge &stayed /slept overnight&resumed journey morning of next day.
Comment:He is alert ,intelligent &did not want to take the slightest risk to his life ,&the lives of his wife& child leave alone possible damage to new BMW CAR.
b)30 yr old (USA) soft wrae engineer was travelling from point A to point B at night 2amHe slept while driving &dashed against a tree.His wife died on the spot,3yr old child recovered after 6 months of treatment for fractures.
Comment:He is stupid &unfit to be a driverHe is lining with guilt throughout life.I HAVE KNOWN ATLEAST 3 DRIVERS(DOCTORS!) who have broken their bones at least thrice due to reckless driving.
c) 30 yr old doctor,driving alone fromdindivanam to madras in 1970.One senior most police officerm,&a senior most IAS officer hithicked doctor's car as their own vehicle got broke downThey were returning from chidambaram after an official enquiryOn the way it was raining cats &dogs.Doctor stopped the car,Officers urged that they should go to assemblybefore 10 am.
doctor refused to oblige.
comment:doctor did a good job.Everything comes after only self safty.
CERTAIN RELEVENT STATISTICCS;U S A.(Indian statistics will be higher)
100,000 car crash every year due to driver's tiredness.
60%drivers said they were DROWSY.
34% drivers said,they felt asleep while driving.
22%-rear impact crash
30% side impact
25% fatalities
50%front impact crash-40% fatalities.
25-50% distractions--cause of car crash.
Every 13 mts-some one is killed.
Every 15 sec some one is injured.
11000 lives estimated to be saved by seat belts.
Conclusion:Now tell me who is a super driver?Are you one?You must be jack of all trades of driving departments.Nothing should be too much &nothing too less.Everything should be balanced .constant vigilance of your sorroundings is essential to make one a SUPER DRIVER.
Unfortunately thereb is no concept of issuence of a super driving licence in any country to give a recognition between a graduate &a post graduate!.

.

MY WEB SITE --TOTAL CONTENTS.

2008-02-03T07:16:00.000-08:00

Following is my plan of full scheme of the contents of my web site regarding the coverage of matters I INTENT TO WRITE W.E .F. APRIL 2008, after I reach Chennai, one by one gradually after collecting necessary materials.

The Plan

Various medical topics of practical importance to a common man to equip himself with a better medical knoledge,as already listed in the blog.
My own family photos.
My own clinical photos published in the medical journals.
Roots of dr.p.selvaraj.-My ancesters from my grand father to his great-great-grand sonswith photos(with a view& wish that my children may continue from here.
BRIEF HISTORY OF MY BIRTH TO CHILDHOOD,INCLUDING THE VARIOUS MIS CHIVES &"SCIENTIFIC EXPLORATIONS".
MEDICAL SITUATIONS THAT BAFFLED ME& HOW I scientifically handled them successfully.
New treatment concept designed by me &published in medical journals.
How I escaped death so many times LUCKILY.
Hardships I faced in childhood &in my professional life.
Some of my saddest moments in my life.Some of my life's happy accasions.
AIDS--From etiology pathology &pharmacology presented by me in a poetical style with a hidden note about control of spread of AIDS.

Highlights

144 stanzas,--576 sentences.
complete proof reading &suggestions by,Dr.A.Parthasarathy,retired professor of pediatrics,past president of Indian Academy of Pediatrics.
FORWARD BY KAVIGNER.S VAIRAMUTHU,well known cinema lyricist.
recommended for all medical officers in the southern command by AREA COMMANDER(lieutenant general), TAMILNADU ANDHRA KARNATAKA KERALA area.
Two sample stories for children's school drama, English elocution contest.

My future plans will include the following from April 2008 onwards

world's rare photos.
madras news.
madras gossips
madras web sites --business, real estate etc., for NRIS
laughter the best medicine-that which realy happened in someones real life.
above 5 sections will be updated every friday. Readers can also send their own for publication here for others just to laugh.

FOR SENIOR CITIZENS-TIPS TWENTY FOR HAPPINESS IN PLENTY.

2008-01-29T11:53:00.000-08:00

Eyes dont see what the mind doesn't,is a dictum in medical world &is applicable to all walks of life.The following tips are given so that senior citizens can take adeqate precaution towards a peaceful,pleasurable,&painless longivity as they go nearer to the fag end of their life.
1)stair case steps:allways beware. you may fall down if you are careless.many people got their bones broken,or got a heart attack,on the stair case.
2)bath room:This is also a suitable place for fractures, dislocations, heart attaks.take care.
3)road crossing :.extreme caution required as you are old,weak physically,hypertensive diabetic,.transient ischaemic attacks(giddiness due to brain blood vessel blocks)cross road only at pedestrian/zebra crossing/ along with other people.
4)avoid travelling alone.
5)never take the risk of going out at night,specially alone.no help will reach you at night,
6)beware of saterday, sunday, holiday.-Availability of medical fecility is least on these days.Many heart attacks are said to occur on these days.
7)Avoide lifting young kids--you may drop them.
8)No alcohol except in your own room.Keep a calling bell in your room,to call others in the house when you are in need of medical help,like chest pain.
9)Amnesia:forgetfulness..you may repeatedly take same medicine due to forgetfulness.If you take anti diabetic drugs repeatedly your blood sugar can come down &you may become unconscious.your doctor can suggest a good solution.
10)Keep your identity allways in your pocket,including phone numbers.
11)Keep instructions in writing in case of eventuality for others to take appropriate action
12)Keep mouth dissolving monosorbitrates allways in pocket.ONE tablet to be kept under the tongue if you get chest pain,unexplainable sweatings ,sudden left shoulder left arm pain-lightning in nature.IF YOU CAN AFFORD KEEP A DOMESTIC DEFIBRILLATOR.Many rich people succumb to heart attacks within minutes.These people may be the bread winner or their serv ices are required at any cost.the concept of domestic defibrillators in well to do families are not yet in vogue, in India..I am sure many precious lives could be saved if only this machine is available within minutes.When a man gets heart attack ,there is no pulse,& no respiration cadio-pulmonary resucitation,(external cardiac massage will be 100% useless.It is a futile attempt &waste of time.D.C Shock(defibrillation)through defibrillator is one &only choice &many times it was found to be successful,in reviving the man or woman.consult your doctor who may appraise you in great detail.Rotary/Lion's clubs can organise this concept.I am willing to do the spade work,if requested.
13)Wheezing in a non asthmatic may be a sign of heart problem(All that glitters are not gold, all that wheezes are not asthma).call for the ambulance quick.
14)Black out experience,may be an indicator of heart attack,or brain blood vessel block,or low or high blood sugar or low or high blood pressure.Call ambulance.
15)Physical exercise is a must till the last day however less it could be.
16)Avoid self driving at nights,specially after alcohol,tranquillisers.
17)Better to have a dog companion depending on living conditions
18)Try to keep half stomach instead of full stomach at nights(heart attacks more in full stomach)
19)Never enter into emotional encounters.YOU CAN NOT CORRECT THE WORLD. DONT POINT OUT OTHERS MISTAKES.YOUR OWN KITH &KIN MAY BOYCOT YOU.
20)KEEP GOOD BANK BALANCE LEST YOU LOOSE RESPECT FROM OTHERS,,INCLUDING YOUR OWN CHILDREN .

&HIGHLY RELIABLEOST USEFUL
.

DIARRHOEA IN ADULTS-OFFICE GOERS.

2008-01-29T08:32:00.000-08:00

Alternate tittle -- Irritants that increase gastro intestinal motility

Introduction
Adults defecate once or twice a day.Many prefer to have psychological satisfaction only if they visit toilet twice a day at least.When they visit toilet frequently they often put the blame on INFECTION,though it may also be a contributing factor. Listed below are some of the usual causes that go unnoticed for frequent bowel emptying.Any one single cause though is good enough often combination of causes on the same day may result in this disorder. Though all are important sugar intolerance in adults &milk intolerance,may be a common cause next only to hot green chillies which is an important ingredient in all the homes &hotels (specially in non-vegetarian & road side restaurants)

Gastro intestinal irritants:1)chillies green/other varieties.
black pepper ,cloves.
cow's, bufullows milk/coffee/tea+or - smoke cigarettes.
hot food.
full stomach.
junk food fast food ,food taken in a hurry.
sweets.
fruits specially mangoes.
milk&sweets may have a cumulative effect even when taken on alternate day for two weeks in a susceptible individual.
frequent hot coffee,tea,with quick puffs of cigarettes smoking
wheat/rye/corn protein
any pickles.
office stress.
multiple combinations of above on a single day.

SOLUTION

Peptic ulcer syndrome(stomach ulcer)is said to be due to Hurry-burry, curry, worry.Alcohol aggravates ulcer disease.These people will also have small multiple ulcers in the in the stomach &bowel motility.The treatment has to be individualized &need based.Office goers should take a light break fast & should not resort to full meal.All the above listed causes will have to be controlled.Non spicy diet 1/2 of limited meal of hotel food without milk may offer a comfortable feeling.

A sample diet that can cause DEFINITE PROBLEM.

6 am:hot coffee with 250 ml of milk
8 am: 4-6 iddlies, with chlly chutney/chilly sambar/chilly powder.
1 pm full lunch, sambar, rasam, vegetables fish/mutton/chicken,curd rice +pickles,banana-1
5 pm :coffee, 250 ml milk, dosai. mango-1
9 pm rice, sambar, rasam vegetables curd rice + pickles + rasa gulla(sweets)

This kind of food if taken even twice a week is to cause problems specially in the retiring age group of people.

USEFUL TIPS IN PREGNANCY

2008-01-24T07:38:00.000-08:00

Child birth is like collecting honey from ajungle tree.WE HAVE TO TOLERATE IF BITTEN BY HONEY BEES. Similarly immediately after the delivery of the child,the mother's joy is boundless,but to enjoy the fruit of labour,she has to bear certain pains,discomforts,etc.
1)TO AVOID MORNING SICKNESS:
a)Keep taking food in very small quantities,every 15 mts..Dont take break fast in one stretch.Take 1/4 iddly or 1/4 slice of bread every 15 mts
b)take fried vegetablesas salad(no oil please),mixed withskin of citrous fruits-lime,orange.(AMERICAN JOURNAL OF OBTETRICS &GYNECOLOGY)
C)add ginger 1-2 gms dailyfor 4-5 days only.
2) To avoid stretch marks in pregnancy.
Start applying vit E capsone once daily(umbillicus to hip level) &butter in the evening daily on the same spot,till pregnancy is over.This is for prevention only.NO effect on previous scars.
3)To avoid belly protrusion.(post delivery)
a)Eat 50 % less but nutrtious with more protien
b)avoid all oils/ghee/fats/n.v items excepteggs, fish.
No large quantity of food at a time.
d)dont eat rice in the morning
e)physical excercise:sit on the floor with legs stretched in front.lean forwards &touch grat toes,&backwards with hand support.start 20 times morning evening.This will dissolve abdominal fat&increase abdominal muscle tone.
f)abdominal binder at all times except during sleep.
g)measure abdominal girth in centimters &keep the records daily once.Suppose the binder is placed at 100cm today(length of abdominal circumference.Keep reducing 1 cm of the binder length every week &proceed till you can tolerate without discomfort.
If all the above tips are put into practicemeticulously ,there is no failure.
HYPER EMESIS GRAVIDORUM:
when the vomiting of pregnancy is uncontrollabe despite all measures,peple get depressed. some people will advice powerful anti emeticsor tranquilisers available over the counter (india)It may do more harm to developing embryoDo all permutations &combinations as outlined above.This is not a disease,but the body's reactionto the growth of a foriegn body inside(foetus)

BREAST MILK INSUFFICIENCY-FOR NEW MOMS

2008-01-23T09:52:00.000-08:00

Introduction:All women who delivered a child invariably makes a complaint thus:"I have insufficient milk to feed my child" or "my baby is having an aversion to breast.He simply turns his face away"Scientists have proven from time to time that these statements are not true.Many mothers expect that breast milk must flow just like bottle milk.THEY OFTEN FORGET THAT BOTTLE IS LIFELESS &BREASTS ARE FULL OF LIFE involving complex mechanism .Those women who are calm quiet,docile type dont encounter such problem.Though the milk may flow from the breasts the switch board to put it on or off is in the brain(hypothalamus).For the first three days or so there is consentrated milk flow(colostrum)(seempaal in tamil)This is highly nutritious &contains lot of materials(gama globulins) that helps to defend the neonates against any harmful germs,and a substance todefend against neonatal diarrhoea(bifidus facter).Apart from cholostrum there will be lot of mucous in the milk ducts causing obstruction.So milk flow insufficiency is very commonin the first week, besides other causes listed below:
1)lack of nutricious(protien) diet
2)ANATOMICAL ABNORMALITY IN THE BREAST,THE MILK DUCTS,NIPPLES)
3)EMOTIONAL DISTURBANCES(anger, easy excitability
4)lack of calm quiet peacefuldark,plasant atmosphere&environement(leave alone mother-in-law problem!)Breast feeding is a tecknic all nursing mother should learnfroma quqlified lady doctor systamatically.The custom in tamilnadu is to give white shark fish(paal sura)(sura puttu)
for nursing mothers to improve or increase milk production.W heather it is true or not it is good for all non vegitarians as it is a good protiencan help produce milk."If there is a will there is milk allways" is a medical dictum.Baby may develope an aversion under the following circumstances.
1)sweat smell from mother's axilla
2)unchanged blouse
3)wet diaper.
4)lack of slight manual breast compression by mother while nursing
5)illness like fever constipation, or any physical irrtationin baby.
6)developing breast abscess due to milk duct obstruction.
SOLUTION:
MILK PRODUCTION IS GOVERNED BY HORMONES.ONCE MILK IS SECRETED IN THE LACTIFEROUS GLANDS,it should flow throughducts,into the nipple&this is controlled by brain for initiating a "let down"reflex for milk to flow freely when the "key opens the lock"at the brain level.The key will open the lock only if the child sucks,sending message to brain to open the lock.So the initiating nervous reflex to let the milk down takes place thus:child sucks--message transmission to hypothalamus--hypothalamus sends message to breasts to allow the milk to flow.

BREAST MILK INSUFFICIENCY-FOR NEW MOMS

2008-01-23T09:50:00.000-08:00

SLEEP PROBLEMS IN CHILDHOOD

2008-01-21T08:34:00.000-08:00

Introduction:Many behaviours of children are attributable to the kind of sleep they have,because sleep is a central nervous system phenomenon,that influences on the intellectual capabilities.Though the problem can occur at younger age,it is significant only after age 5 when definite signs symptoms can be assessed by doing an I.Q.test.
Following are manifestations of different types of sleep disturbanses:
1)sleep apnea:cessation of breathing for few seconds during sleep.
2)over sleeping(more than for his age)
3)under sleeping(does not sleep more than an our continuously,but may like to sleep repeatedly in the day.
4)dreams;In quiet refreshing sleep there is no dreams which are burried thoughts deep in the unconscious mind trying to surface to the sub conscious mind.
5)REM sleep-rapid eye movement sleep.
6)SEM sleep -slow eye movement sleep.This is wanted &refreshing.
7)sleep walking-somanabulism.
8)Bed wetting in sleep at night( after age 5 for practical purpose)
9)Teeth grinding in sleep (wrongly believed to be due to worms!
10)Narcolepsy (sleeps more in day time &night time.Gets often comulsive sleep
on a sudden onset
11)EEG recordable abnormalities in sleep
12)jet -lag.
SOLUTION:All these disorders are due to a dis turbance in the flow of electrical transmission in an abnormal way,disrupting the normal BIOLOGICAL CLOCK. For every body function there is a biological clock system in the body.For example in jet lag ,we cross 2-3 time zones in a short period,while flying in an air craft for a long distance.So the condition reflex already functioning is shattered resulting in ,head ache,drowsiness,inattentiveness etc.So only way to set right is to go to an experienced pediatritian,or a psychologist.or a specialist in sleep medicine(available in CHENNAI) Psychological counselling,psycho pharmacological drugs are often prescribed by doctors after finding out the causewhich is the hall mark in ultimate management of any illness.

SCHOOL DROP OUTS IN CHILDHOOD

2008-01-21T06:14:00.000-08:00

This occurs in the most affluent to most down trodden in the soceity.
Causes:
1)Lack of patterna/maternal controle over children in the 10-15 yr age group.Most vulnerable around age 11 yrs.
2)Lack of supervision when their academic performance falls below average.
3)ACCESS to free flow of money in their hands,which leads to seek extravagent life.Allowing children to return home after 6 pm,even for a single day if it is unexplainable.
4)Allowing children to go to cinema theaters,visit bars,visit places of gambling in the name of recreation clubs.
5)Allowing children to play cards during study time or any other gambling,smoking /drugs loitering around town without any aim.
6)stealing money at home(Not informing husband if mother knows about it)So the charecter is lost in the already indisciplined child
7)Boys outnumber girls ,because they are given more freedom
8)Beating&scolding children unnecessarily.
9)Matrimonial disharmony in parents,diverting their anger on children(very important)
SOLUTION:
All these are fully correctable,provided parents interfere at the right timewith right steps,or bring it to the notice of an experienced pediatritian or psychiatric consultant.It is a pity that these people dont make use of the doctors for such matters.Early &late adolescence are challenging age to parents who should anticipate &seek the help of doctors whenever they suspect that the path chosen by child is not upto mark of satisfaction.50% of all children are potential drop outs unless carefully supervised.Most of such children become appreciable citizens ONLY because of constant supervision by parents ,teachers who guide them now &then &continuously.

SUICIDES IN CHILDHOOD

2008-01-20T07:20:00.000-08:00

Suicides are not uncommon in childhood population.It is the mental make up of children that drives them just like adults. but the cause here is different.Anger,dissappointments frustrations,financial loss are main causes in adults.
Age incidence:6-16.both sexes. sex ratio:F:M=4:1.COMMENEST AROUND 14 YRS.
Usually due to desperate psychological stress &prior knowledge of close relatives'
&friends' 'suicides.
Causes:1)Too much ragging in school,college, soceity, teacher,parents.
2)Scoldings by elders in such a wayto feel ashamed.
3)Physical beatings causing injury ,pain specially in the presence of others.
4)Sex abuse..
5)Death of mother, father, bosome friend.
6)Failures in examinations.
Real life story:15 yr old girl just usedto talk to a boy.somebody informed this to her father.what happened in the family discussion is not known.She was found to have consumed bug killer poison &died within 2 hrs.Her brother ,doctor30 yrs commited suicide in the first night after wedding.Her eldest brother 45 having 2 kidscommitted suicide for reasons not known.Allthese three had one thing in common -extreme sensitivity to react to a stressfull situation They never thought about their parents for awhile.children must be taught that suicide is not the answer for any problem.Many young girls commit suicide when they were raped.This kind of suicides are more in india than in USAwhere people's outlook about chastity is different as they are brought up in a different culture.40 yrs back there was a film by name TWOWOMENwhere SOPHIA LOREN WAS THE MOTHER who washes herdaughter's genitals with water from a canal that was found on the way&said "All the dirt is now gone"That should be the spirit of mothers instead of cursing them that their life is gone once for all as the" chastity" is gone for no fault of thier's &that they are unfit to live.This is a vain philosophy.Girls brought up in this phylosophy will ,have suicidal tendency,because that age is neighther too young nor too matured to know how to react,unless primed earlier.All children must be educated from young age onwards,that suicide is1)an act of cowardice.2)tendency to escape being unable to face real situation.3)extreme sensitivity will not be helpful in real life4)is such that if a child commits suicide parents also may commit same or die of heart attack5)may cause collapse of family structure.
All female children should be brought up like male children to be bold telling the stories of some bold ladies who are known for their bravery.
Prevention:1)Exam fear should be removed at all costs.
2)children's mind should be nicely primed that suicided children will be cursed by society,after their death.3)It is a shameful thing to commit suicide.4)PARENTS MUST PROVIDE A CONGENIAL ATMOSPERE that does not threaten them towards such a misery.
Relavent true life story.
-----------------------
A boy was failed three times in finalMBBS exam due to personal vendatta by an examiner.The boy had a strong will power ,got the exam center changed& passed exam.He did not commit suicide.So the lesson learnt is that there is another solution other than suicide for any given problem.This should be convinsingly spoken to them that they remember it for ever.

SEX ABUSE IN CHILDHOOD

2008-01-18T06:23:00.000-08:00

Introduction:

There are many parents who think that they need not know about sex abuse &suicidal tendencies of childhood."Eyes dont see what the mind does n't".Parents should have an open mind to discuss these matters whenever they see a TV News or any other relevant accasion if there is a news in the dailies.There is nothing to feel shy about it.It is better they learn these things through parents than from any other source.

SEX ABUSE:

Usual age &sex affected:Any age & any sex.

Mostly men above 50are involved who are unsuspicious strangers,who are single.

Some reasons why these perverts choose children.

1)They are defenceless &can be frieghtened easily.
2)From time immemorial there is a myth that "those who suffer from VD can get cured if they have an affair with a vergin.
3)Mostly anus is the anatomical site involved.So if there is bleed in the external genitals or at anus,parents should suspect a possible sex offence.

PREVENTION:
1) CHILDREN FROM AGE 10 upto15(some times even younger)should be told not to accept sweets eatables,soft drinks,ice creams from known or unknown people.Tell them like this:
"If your teacher some body known to you calls you to meet you to an isolated lone placefor an interesting matter-like free ice cream ,or free cooling glass, dont go"
"Beware that something funny may take place there.they may kidnap you&sell in some far off state."
"If you get stuck up.Be silent.dont talk. THINK ABOUT HOW TO ESCAPE"
"Never friehgten the kidnap criminalsby saying you will inform police while you are in their custody"
Whenever this kind of real life news are published take this opportunity to discuss with children

CHARECTER CONSTRUCTION FOR CHILDREN

2008-01-13T14:47:00.000-08:00

This also is a systamatic sophisticated structural construction from early childhood &it would not sprout all on a sudden.This is like a building raised with foundation &slow step by step construction work of psychological "bricks &cement".If the "materials "used are, not adulterated the resulting building(child) will be strong,long standing.
Father or any other male member , mother or any other female member, should be available to be a role model for the child.children automatically learn to be a hero worshiper.But the role model should possess all virtues,including good dressing sense,polishing of shoes,punctuality maintainance&decency in all behaviours.Exemplifying model should have sense of humour &euphimism which should be taught to children then &there with actual life situation..If father & mother possess all these, children will imbibe these qualities.Teach children in the young agefrom age 5 onwards to address elders with respectful terms,including father &mother.( eg:
"vanga" "ponga" in tamil meaning:" come ,go"insead of" va po" while speaking to parents) Like charity everything begins at home.Relevant story:I studied the story of a "VILLAGE SCHOOL MASTER" in english prose, while in form IV.The school master served as a single teacher in 18 th centuaryHe had a duel duty of teaching children in school& unofficially educating the the villagers on day today affairs.The villagers were approaching the school master for the following issues.
1)To find out wheather it will rain today or not&if agricultural works can be started or not
2)how to apply manures to land &how to give medical treatment to cows &bullocks if they are sick,as if he was a vetrinary doctor!.
3)when will be the right time for harvesting.
4)how to raise poultry.
5) how to hatch the eggs
6)how to go to another village--direction &route
Parents should be like the village school master &educate their children continously at all times on all days.Unless you show them love & affecton, give enormous sense of security, they may not obey you &attempts to discipline them may be a tough job.

Descipline Enforcement --Parents Duty

2008-01-12T14:20:00.000-08:00

All my wright ups are not going to be likewhat you read in books.It will be more purposely personal &will kook like man to man(one to one) talking so that the readers understanding will be easier& a gainful pastime

How exactly the job of exicution of discipline to be done in lfe in practice?

pactical procedure:

If father &mother are disciplined children will automatically become disciplined.POINT OUT THEIR MISTAKE, gently &politely without using harsh words.Dont beat children.But act as if you may beat them in all probability.YOUR VERBAL TONE MUST BE SERIOUS.Dont use vulgar language. I f you find them using such filth,take it easy &conincingly speak to them ,what it means,what effect it will produce on the person scolded & how it will reflect on his own charecter.SURELY TELL THEM it will assasinate their own charecter.Put a question weather "you want to be good a good citizen or not"."You want people to praise you or not?"If they repeat mistakes,give warnig twice,&act on the third time.Ask them to kneel down for 5 mts for adament children.(This is not advocated by few psychiatrists.)Alternatively you can tell them you are not going to talk to them.usually they will come to terms.some times if you give group punishment that will be o.k. &no one will feel guilty.After all what is discipline?Doing good things with motives for good purpose &good benifits so that life will be smooth &peaceful&without worries.Explain to them why the punishment was givenSay it is only for his betterment.Dont compare your son with other children.
Disipline required in the following areas.
1)Getting up from bed &going to bed in time.
2)Take cofee after brushing teeth.
3)Toilet ,bath at fixed time.
4)Keep things back in the same place
5)Nail cutting weekly onc
6)work while you work& play while you play
7)Never allowgossiping,no indulgence in wasting time.
8)Dont ask them to study often;but keep an eye on the home work done .
9)Let them do some drawing, painting or work of arts like making ship aeroplane etc etc from papers
10)Let them learn game of chess.hand held video games.(it will developethe mind for calculative thinking,&mental &motor coordination)&provide as a temporary escapism from study.
Many parents show their angerwith children&beat them when their actual anger is with their spouces.Though this is a psychiatric problem this is to be done never.

NEEDS OF A NORMAL CHILD.

2008-01-10T12:38:00.000-08:00

aA CHILD needs a carfully supervised observation with masterly expectancy,from birth to late adolescence,as briefly outlined below:
1 a.prenatal stage:Rubella vaccine at prepubertal stage to mother.Folic acid from pre concieved stage with good food &vitamins&trace elements like zinc ,copper, manganeese,molybdenum to mother.
1 b.Natalstage;Good obstetric &GYNACOLOGIST &NEONATAL RESUSITATION care.
1 c.post natal:Breast milk atleast for first 3 months.Colostrum is madatory.
2.Nutrition as outlined: protiens,carbohydrates, fats,vitamins,minerals,metals &trace elements.
3.Immunisation.
4. Give love affection. Teach obedience&discipline Let them have a mild sence of fear to parents,but keep a friendly relationship.
5Confirm good school,good education,good teachers,&good friends.
If all these are provided a child can not become abnormal .He will be one of the most cherishable citizen of the world.
A true life story of one relevant thought provoking incidence will not be out of place.

THE STORY OF WOLF-RAMAN.
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(for mothers of children below 2 years)
Introduction:This is classic example of how & why children grow up much against our expectations..Even though brain functions are different according to various species of animals
human brain is totally different from all other animals in its learning &storing capacity,depending on environmental stimulation.THERE ARE MANY AREAS OF THE BRAIN WHICH ARE NOT WELL EXPLORED BY SCIENTISTS,who say that what we donot know is much gretar than what we know.To exemplify this philosophy ,there can never be another story than that of wolf raman's that happened in real life.
Actual story:
A man went in a jeep inside ajungle for hunting.He heard a funny noice that prompted the hunter to trace the animal from where the sound originated.To his surprise& shock he saw a naked boy about 2 yrs of age howling like wolf,with all other mannerism of wolf.The hunter with great difficulty brought him,named him as raman &admitted him at CMC vellore,tamilnadu India around1956.For a long time the News of raman appeared in all the news papers.It was construed the child should have been seperated from its parents for some reasons and was mothered by a mother wolf probably from neanatal age onwards!No one knew who the biological mother was.Plenty of foriegn doctors thronged CMC vellore,like flies over a jack fruit!.But they could not save the baby who eventually died,after 2 months despite desperate attemt by a team of doctors.
Discussion:This boy wolf Raman should have never seen or heard ,human voice &language from birth onwards.He was exposed to an animal world &seem to know only animal language(wolf)That includes food habits & other bejavioural pattern of animals Brain is a complex & most intricate machine,where knowledge is is recorded slowly &systamaticallyThere is continuous exposure to many sophisticated things like hearing, seeing understanding with apredictable & precision outlook&constant feeiding of same information repeatedly +new infermationalso now &
then. An animal brain can not do what a human brain can do.Similarly a human brain can not be better in an animal environement where there will be constant deterioration &degenerationEven an animal living in jungle is inferior to another animal living amidst human environement .But a human being exposed only to animal world for a ptolonged period only animal language & knowledge alone will be recorded in the brains anatomical&physiological &psychologicallayersSuddenly if such a human young one is seperated from animal world&attempted traing for a human behaviour will be futile.
Conclusion;A child's brain functions like a compeutor chip where messages are constantly recieved stored &retreved .Its style of functioning is different from animals.But if the ENVIRONEMENTAL STIMULATIONrequired is not provided by seperating the child away from human atmosphere the brain cells get "rusted" once for all & unfit for further recording of messages.This is what happened when wolf RAMAN was brought to human atmophere.So if our human brain"s capabilities are high ,it is due to constant ,uninterupted cognitive ability which is becoming better& better after each generattion,& the knowledge is passed on to offsprings,boosting up its growth potential through GENES.

CHILDHOOD ACCIDENTS for the knowledge of parents.

2008-01-06T08:45:00.000-08:00

DEATH RATE IN ACCIDENTS IS HIGHER THAN IN DISEASES.Children are more prone to accidents from birth onwards.Commenest till age 1 is aspiration(food particles finding entry in the wind pipe)Younger the age chances are more. Althoughparents know all the possibilities of accidents it is better they are aware of a list of few very common accidents well in in advance, so that things will strike in their minds more quickly.Certain qoutable examples:(Remember EYES DONT SEE WHAT THE MIND DOES N'T)
1) Aspiration while feeding in head low position or if put down without burping
2)Swallowing tiny toys,tiny articles like small finger rings.(All children explore everything orally as research (especially crawling babies)
3)touching electrical wires espcialy if located at one or two feet above ground level.
4)hot rice congee, rasam, sambar, hot water ,not to be placed in the kitchen,just on the ground even for a second if there is a crawling child or or toddler in the house
5)All water containers should be covered with a lid.
6)Poisonous substances,agricultural chemicals,medicine used by elders dettol,phenyl detergents not to be placed at ground level
7) children's shoes must be physically examined for any poisonous insects before wearing them every day.
8)EVEN TROUSERS SHIRTS SCHOOL BAGS must be scrutinised everyday by the mother.
9)An adult should follow the child in another cycle &teach him what to do &what not to do in a busy place&point out the mistakes to avoid accidents.
10)SOME SCHOOL CHILDREN GO IN A ROW obstructing the entire breadth of the road.
Suddenly if a vehicle comes in front or behind they go helter scelter &sometimes the edge of the road is 6 inches at higher level.The cyclist is unable to get above the road resulting in skid &fall.If there is a speeding heavy vehicle from behind,an accident becomes unavoidable.I have seen a similar kind of tragedy where a young college girl died near MANI HOSPITAL,THENI TAMIL NADU.WEARING HELMET ALONE IS NOT GOING TO HELP THIS KIND OF ROAD TRAFFIC ACCIDENT.
11)Examine school environement .Find out if there is any thing that can cause danger to children(your child is studying there!)(one 3 year old died inside school where there was a slushy pond by getting drowned as if in quick sand at choolaimedu chennai.
12)Dont allow children to swimming pool,big wells, lakes,without proper care taker.Beware of snakes if there are bushes around house.
13)where ever possible make improvisations to prevent& protect from a fall(eg;putting small doors near stair case.)
14)Never leave child alone.He may lock himself or or shove his head inside a small iron ring.Automatic locking doors may be risky.
15)All pets may be problamatic.Any dog bite can potentially cause rabies,for which there is no treatment.
16)Lock the car doors carefully.Ensure your childs fingers are safe lest they get crushed!
17)children are prone to get injuries at,fore head,teeth,chin,elbows knees,specially while learning cycling.
18)When there are lot of guests &you are busy ,have an eye on your toddler.He could fall down from second floor or get drowned in the water tank or get kidnapped.I have seen all these happening.
19)Taking wife & children as pillion riders in two wheelers is highly risky.

GENERAL ADVICE TO PARENTS ON CHILD RAISIN PRACTICE

2008-01-05T07:21:00.000-08:00

1)mAINTAIN HYGINE SANITATION.
2)Get your doctor to do a monthly medicalinspectionof the childs residential environement&attend well baby clinic if available.
3)All immunisation shots are essential as per scedule.
4)pox lesions &other viral infections are common around april.Hence get vaccination shots appropriately early.5)diarrhoea is more common in april as the fly population is higher during the fruit season.
6)best way to prevevent carries tooth is:wash the mouth, mouthgargle after eating sweets ice creams.Remove non veg particles immediately after food from teeth
7)Family as a whole should have Anti-worm treatment once every 6 months
8)TEACH CHILDREN SOMETHING DAILY FOR 5-10 MINUTES WITH AN AGENDA before dinner including prevention of accidents while cycling.
9)beware of your childrens friends circle&spy on them if there is unsatisfactory behaviour or any kind of suspicion
10)if the academic performance is low,consult doctor &teacher immediately.

TEN COMMANDMENTS AGAINST COWS MILK

2008-01-02T09:23:00.000-08:00

Breast milk is for the baby& cow's milk is for the calves.This is an old dictum &it holds true even for today.Gone are those days when we use to suppliment breast milk with cow's or bafallow's milk.We didnot realise those days that cow's milk has harmful properties until scientific data started pouring in much against cow's mailk &various scientific studies indicated when comparative studies between breast milk alone fed babies &cow's milk alone fed babies were available;the former group had fewer problems than the latter group.
For the knowledge of parents for both for the sake of their children&for themselves too.Cow's milk is blamed for producing many untoward side effects to children.Tho(ugh they are not highlighted for the sake of doing so the facts have been proven beyond doubts&published in the medical journals atleast 3 decades back itself.&achnowledged by busy,leading pediatritians.
"THE TEN COMANDMENTS"
1)LACTOSE INTOLERANCE:Causing diarrheal disorders(A 9 month old child weighing 5 kg reporteed for diarrhoea of 9 month durationShe was diagnosed as lactose intolerance& treated accordinglyShe became asymptomatic within 15 days.
2)cow's milk protien can cause allergy in any form like itching &varius unexplained discomforts.
3)asthma in children.
4)juvenile delinquency.more in cows milk alone fed babies(childhood criminals)
5)cow's milk protien - induced enteropathy;bowel disorders like pain abdomen,diarrhoea(different from sugar intolerance)
6)low academic achievements,in school.
7)one of the alleged cause for minimal brain dysfunctional syndrome
8)can cause frequent unexplained vomitings.
9)urticarial reaction.-bleed-like under the skin
10)can cause joint disability,pain like juvenile rhumatoid arthritis

FOR NEW MOMS---SPECIAL ATTENTION---WEANING FOOD

2007-12-31T07:10:00.000-08:00

The weaning food for an indian child anywhere in the world literally means the change over of diet pattern from mothers milk to other nutritious needs.
All young ones depend on mothers milk only for a certain period & it can not survive without milk,if for some reasons the child is seperated from mother.In the case of other animals(mammals) all animals will die if milk is not availablewithin 3-5 days,as other foods are not digestable.Eveen mammals like lion tiger which are purely carnivorus, raise the young ones with their own milk.after 2-3 MONTHS slowly the change over takes place(weaning)by eating raw flesh.Even here it is worth noting that the mother animals kill a new born animal very calculatively to be the prey for their young ones,because they can not digest the flesh of an adult animalSo even in the animal kingdom we can see how weaning takes place.

Weaning is nothing but change over of food,from mothers milk,till it reaches age one,when it can take full family diet.It is like acclamatisation to high altitude.
If we go to 20000 feet straight we will develope pulmonary edema(water clogging in the lungs)&die.so we go from 5000feet &stay for a week for every 3-5 thousand feet.This will get our lungs used to existing atmopheric pressure.Similarly to digest brest milk enzymes present in saliva &stomach are enough.As the child grows the need is greater.so protien &fats are required for body's construcion process.As the organs grow simultaneously(stomach,gallblader,pancreas) they produce more concentrated enzymes &hormones for better digestion,of protiens &fats.So the quantum &quality food is gradually increased, to yield more energy for day today life,&for body tissue growth including brain.
All the body tissues are immature in the young.The stomach ,pancrase liver kidney small intestines are not matured enough until 2 yrs, to digest veg &non veg protiens&fats taken by adults .That is why easily digestible absorbable &assimilable(process of conversion of food particles to mix with blood),food must be chosen as per childs age(indirectly as per organ maturity)
There is no need to know the various data such as caloriesThe weanig food is availablein the store&all are good.There is only a small transition period from age 6 months to one year from milk to solid.A simple recipe is enough to give home made food.Beware of not giving too much protiens &fats as it may lead to obesity,&kidney stones(aminoacid stones).Too less will cause malnutrition.
A MODEL DIET RECIPE for a child upto age one
3kg--at birth-mothers milk only.
4-6kg-3-6months-mothers milk +formula milk.
6-9months.Allthe above+rice 2 tsp+dal(bengal gram)2 tsp+ghee(gingely oil alternative)1 tsp.GIVE ONCE A DAY FOR-2WEEKS.Twice a day for 2 weeks.Then 4tsp thrice a dayalong with egg once a day.Egg,boiled white from 6 month onwards1/4-first 2 m0nths.1/2-for next 2 months.full egg at 10 months-white only.Plus 600- 1200 ml milk in addition always til age 5..Boiled smashed vegetable 6tsp+fruit juice 6tsp may be added from 6-8 month onwards.Mothers milk as long as available.Definitely upto 1 yr..Preferably upto 2 yrs, Profitably after 2 yrs.AGE1-3 YRS:Full family diet can be given. Take care the rice &other items are well boiled Avoid all spices&all meats upto age 3.small lean fish can be given always from age 1 onwards(about 3- 5 tsp)USUALLY DIGESTION IS NOT A PROBLEM.children do lot of exerciseswhile playingfrom age 2 onwards.AVOID ALL SPICES, SWEETS, ACIDIC FOOD,(PICKLES)FISH WITH THORNS ,FATTY FOOD ,ICE CREAMS.(Any thing once in a way is allright)Half boiled egg,sea foods (,except fish)such as shrimp(prawns)crab ,lobster, etc are all nothing but cholesteol.
The weaning food available in store is not superior to costum made diet at home,which also contains ,all the ingrediets of commercial food,which may contain extra vitamins iron,minerals.But we can supply all these either naturally,or by syrup ,drops.In INDIA vitamine A difficiency very common due to many reasons.So a good dose once a year will help also against developement of short sightedness & is recomended as part of nutrition management by W H O..Various commercial cerial food contains1)carbohydrate(rice,malt, atta,(maida) corn wheat.2)protiens (cows milk soya various grams.3)fats from various edible oils+multivitamins minerals,+trace elements.In addition some contain DHA(docohexanemic acid+ARA(arachidonic acid. These two substanses are contained in breast milk only&said to be good for the growth &developement of brain tissue &retina of eye balls.ADVANTAGE:1)ready availability 2)simple to dispense.3)hygeinic.DISADVANTAGE:1)expensive2)some are non palatable.

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For the New Parents : Face Facts Boldly

2007-12-28T10:20:00.000-08:00

How strong are you ready to react positively, if your child is born with a congenital defect?
Introduction;
No body wants a defective child.But in the unfortunate event of such a birth,can we Afford to throw away the child into a dust bin?Afterall it is our own flesh & blood.IN GOD WE TRUST.Ifthis is true there may be a devine exlanation.But we should accept science&ITS ULTRA RAMIFICATIONS ALSO.All defects are attributable to genes,the ultimate electonmicroscopc fusion defect in an unhealthy internal environement in a fertalised ovum.It is worth while citing an exampleof a truly published report in an Indian journal INDIA TODAY around 1990.A black goat gave birth to a young one with absence of 50%length of left fore limb.This mother goat was said to be gracing around the bushes of a central govt. organisation engaged in atomic energy research &its nuclear energy containg waste.It is probable that the birth of the defective young one was due to the nuclear waste materials eaten by the goat during the early part of its pregnancy.During the same time a mother delivered a child with absence of left forearm+50 % of left upper arm.There is no connection between the two though.THIS occured in csi hospital Erode tamilnadu,india,though she did not give any positive history during her first trimester of pregnancy.It may be due to use of abortifecient drugs for reasons of their own,as it is easily available over the counter.Many do not know that D&C is the best if they choose to abort.Abortifecient drugs can interfere with the developement of growing embryo.in such a way that it can cut vascular supply of the missing limb during the process of developement of the embryo.This medical article written by me was published in the journal THE ANTICEPTIC(1990)INDIAS OLDEST NATIONAL JOURNAL.This mother was given councelling by a team of doctors.SOME EXAMPLES& COMMENTS ON MANAGEMENT:1)Harelip &cleft palate :This facial defotmity is fully correctable surgically.An anglo indian mother alcoholic &smoker gave birth to such a child.Usually surgery is done after one year or after attaining 8 kg body weight.Then only corrective surgery can be done sucessfully.Many hurry up the doctors &get lip closure done in 1-2 weeks after birth in order to face the soceity.2)Talepes eqinovarus(club foot)One or both feet may be affected; fully corectable by age one by continuous strapping. Late cases often need surgery&POP

V S D;Commonest heart ailment often refererd to a hole in the heart..In cases where the diameter of the hole is lesser it may close naturally by itself under very good medical supervision(should minimise crying episodes).Surgery is allways sucessful.Life expectancy is also almost normal.Respiratory infection may be more.
T H A L I D O M I D E TRAGEDY: Thalidomide is a drug having sedative property&was prescribed for pregnant women as an antiemetic to counteract mornig sickness producing vomiting of pregnancy.It was sold by a German pharmaceutical companyGRUNENTHAL from 1957-1961.Before the official prescriptio the company has distributed even 2 years before samples to lot of doctors & was found being sold in over 40 countries.In 1956--62 more than 10,000 were born with phocomelia,including USA.

The SCIENTISTS found many such women yielded babies without all four extrimities,after they bocame pregnant.The drug is banned in all countries.Even today some children are born with Achondroplasia with very small limb buds.Dont they have the right to live?Can the society dump them in a trash box?There are some adults with grotsque faces Are they all evaded by society?I HAVE SEEN ONE OR TWO FACES DRIVING THEIR OWN ROLLS ROYS..SO ARE WE GOING TO RESPECT THE RICHES ONLY &NOT THE HUMANITY? So WHEN A CHILD IS BORN ALIVE it has all the rights to live& the parents should be the first to to support them.It is the brain that is important & not the external appearence.
Are these births preventable?Yes to some extant if the HYGIENE of pregnancy is well managed.Hygiene includes avoiding all inclement atmosphere like alcohol,smoking(active ,passsive),total avoidance of all drugs(Ask your obstetritian to give a list of drugs contraindicated during 1 11 111 trimester of pregnancy.)ALL VITAMINS MINERALS METALS TRACE ELEMENTS SHOULD BE REGULARLY TAKEN TO AVOID NUEROLOGICAL MALDEVELOPEMENTS.IF FIRST CHILD IS DEFCTIVE,BEWARE OF THE SECOND CHILD ALSO GETTING SAME DEFECT(go for genetic councelling)Rubella vaccine in the prepubertal age for all females are mendatery.All said &done,ultimately this is a game of GENES where the the players are46 chromosomes on each side!.
Downs syndrome;commonly seen. babies with deficiency in cognitive ability physical growth&typical facies.this condition is identifyable during pregnancy.This is due to presence of an extra chromosome at chromosome no.21 .These children need special schooling.IF IT IS DIAGNOSED EARLY ,ABORTION CAN BE CONSIDERED.

Immunization - Is It A Must?

2007-12-28T10:17:00.000-08:00

FOR PARENTS SPECIAL ATTENTION;
--------------------------------
Introduction:Vaccination shots are given to prevent infectious diseases in children as these vaccine preventable diseases were taking a high death rate after disease complications 5 decades back when there were no vaccines.Vaccination of children is the duty of every government in order to protect its future citizen.No immunisation gives 100% protection against the disease for which vaccinated.Then why should we suubject our children to possible risk?the RISK IS MORE if not vaccinated
against 12 conventional diseases.Afew children may get problem most of which are managable succesfully if seen by a competant doctor.
PROS& CONS;
----------
ADVANTAGES ,DISADVANTAGES present in every immunisation procedure.ADVANTAGES are too many,compared to disadvantage.For example measles is a deadly disease,that very few escape from its complications I 'm yet to see a child without anyone of the following post maesles complications.1)BRAIN FEVER -fever,fits altered conciousness sleeplessness with irritability.2)pneumonia-lung disease(fever,cough,phlegm ,breathlessness. 3)gastroenteritis-loose mucoid motions sometimes with blood 20-40 times a day lasting upto 6 weeks.)Allthese will cause death if not treated correctly.so measles plain at 9months,&MMR vaccine at 15 months are essential, But some children may develop some auto-immune disorders, like asthma,juvenile diabetes bone marrow depression low blood platlet count(thrombocytopenia) causing bleeding under the skin or even in the brain with relevent problem.The 12diseases for vaccination are as under:-1)tuberculosis. 2)hepatitis B.3)hib 4)diphtheria5)whooping cough 6)tetanus 7)polio 8)measles 9)mumps 10)rubella 11)chicken pox 12)pnuemococcal disease.There are some disease for which vaccines are usually given when there are epidemics (hep A, INFLUENZA,MENINGOCOCCAL meningitis,typhoid,japanese B encephalitis).
A REAL RELAVENT TRUE STORY
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2 YR OLD MALE CHILD ,developed fever after vaccination.found to have bleeding under skin at various places.platelet count was far too less.Blood platelet transfusion was given to save the child.This unfortunate child went to USA ONLY TO DISAPPEAR from this earth ,by accidentally falling down from second floor through the window.USA windows dont have cross bars like in india.It is a pity that USA is a country,which looks after the safty &security of children,constructing windows without safty.one more point parents should note here is that children's death is more common by accident than by disease. The above quoted child is living through 4other children by its ORGAN donation(eye,pancreas kidneys heart & lung.
Even incidence of learning disability like autism as per medical literature evidence is more on the post immunisation era.But it is an unsolved dispute among scientistsThe offending culprit is thought to be due to mercury contained in dpt,dtap injections.
precautions:
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All live vaccines are risky.can cause anapylaxis(drug induced reaction),both immediate &delayed.A COMPETANT DOCTOR KNOWS HOW TO MANAGE SUCH COMPLICATION.Early diagnosis important.If a rash is noted at 9 pm consult doctor at 9.10 pm.dont wait till next morning.Many late evening medical problems have been consulted,in thw next morning only to learn that it is too late. Time &tide waite for no man. BETTER TO AVOID MULTIPLE INJECTIONS ON THE SAME VISIT. THERE IS NO GREAT ADVANTAGE EXCEPFOR AN EASY PARENT COMPLIANCE.
All the vaccines are stricly poisonous substances.If one poison is mixed with another poison the resulting toxicity is 10 times greater,than when they are used singly.If 3 toxins are mixed the resulting toxicity is said to be100 times.Should we subject the young immatured brain tissue to be assaulted by these toxines?This is a question posed by a section of scientists.
CONCLUSION;iS IMMUNISATION A MUST?Yes it is a must,unless long term multi center global studies indicate against it.no doubt auto immune disorders, behaviour disorders, learnig disability are more prevalant in the post immunisation era compared to 50 years ago when the word immunisation was unheard of.

4-8 PM SYNDROME IN PEDIATRICS OR DISTURBED SLEEP BABY SYNDROME

2007-12-15T08:33:00.000-08:00

Introduction:As this article contains a vvolley of in formations it will be found very useful to lot of parents who might visit this site.It is hoped that all new moms grand parends, caregivers, creech owners would ffind very usefulin their dailychild rearing duties.This will be published in a national medical journal shortly.

4-8 pm syndrome in pediatrics:(disturbed sleep baby syndrome)
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Introduction;It is often a nightmarish experience,if a very young child cries violently,all on a sudden,as if beaten by someone,black&blue.Face often turns red.Tears flowing like water falls.parents become panicky.refuses to feeds.STOPS FOR A SECOND ONLY TO RESTART THE WHOLE EPISODE once again .1/2-2 hrs cry is quite acceptable though painful.EVERY parent has to undergo this bitter experience once in away atleast during child raising practice.What is the cause?Is it preventable?How should one meet such situation?Is gripe water an answer?The auther has not come across to get an answer after searching the world literature .Hence this attempt.There are instances where people have phone called 9 1 1(ambulance/policein U S A)

WHAT IS IT ?
-------------A new born often sleeps 18 hrs a day.may wake up & cry every 2 hrs for feeds.NEONATES go to sleep almost immediately after feeds/burping.Feeding duration increases after 3 months. But may start crying for no OBVIOUS reasons.common causes for crying are listed in tables.
Table one;

hunger

thirst

itching sense anywhere

0bstipation/constipation.

diarrhoea

vomitig/regurgitation

hiccough

wet diaper.

unplascent atmosperic temperature

crude unplacent noices(noices from fan fridge, washing machine air conditioners are said to be producing sedation &sleep ;hence exclude from crude noice

fever.

post immunisation.

Any recent intra muscular injection.

wheezy chest(asthma)

severe pruritis anywhere(itching)

unplacent atmosphere.(cinema theater)

lack of mothers presence

stomach upset(gastro esophageal reflux),strangulated hernia,hiatus hernia,intestinal colic ,intussuseption,worms intestinal obstruction(abdominal dis tention,vomiting,fever,acute pancreatitis)

Table-two. Causes of continuous cryingfor hours/days.

abdominal pathology giving pain

venomous insect,scorpion sting,with or without cold arms,legs,

acute bronchiolitis/asthma unrelieved.

heart failure due to any cause(HR over 120-140 gallop rythm

jet lag .

congenital megacolon(passing stools once in 10 days or so,habitually)

Auther's experience:

One yr old brought for sleeplessness&;continuous cry,-duration72hrs.Already seen by 10 docters&;treated with sedation/injections.on exam;Restlessness.unable to fix child for i.v. injection.very loud cry.heart rate 200/mt,cardiac pulsation visible outside.Child rolled in a blancket to give iv scalp vein inj.Digoxin+lasix one dose given.cry lasted for 15 mts &slept.woke up after 3hrs& found playing.HR-100/mt.Had one full feed after 3 days..Discharged at request.
Auther's hypothesis
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The syndrome is due to a chaotic situation ,arising in the central nervous system,due to electrical impulses running in the axons&dendrites of the nervous tissues of the brain,inthe most disorderly way.LACK of sleep is the main cause.Sleep is a condition reflex,developed over years.FROM new born period onwards sleep duration decreases slowly to 6-8 hrs by age 12 yrs.Why should it become crancky,in the 4-8 pm period in the under 2-3 yr age group?When the child wakes up in the morning the alpha weaves are more in the electro encepalographic weave pattern(E E G) when it sleeps at night(complete unconciusness),theta weaves are predominent(the above facts are established )The developement of these are due to flow of electricity; it takes its own time as per maturity of the brain tissue,;it comes to a fair degree of satisfaction at age 2.The developement ,transformation&predominence of THEETA weaves usually takes place
usually around after 4-8 PM So the 4-8 pm time is the most vulnerably disturbed time&;hence the restlessness,cry inability to put to sleepy mood.This hypothesis can be confirmed or dismissed only if serial EEG is takenfrom 6AMto 8 PM IN A SIZABLE NUMBER OF CASES&RETROSPECTIVE analysis made.Many mothers put the babies to sleep in a swing &put the child in motion in order to make them sleep.This effect is reflected in the possible,coinsiding production of theeta weaves in EEG making them to sleep.
ONE MORE POINT WORTH MENTIONING IS THAT THE CHILDREN WHILE CRYINGsqueeze their eye balls& skull,above motor cortex of the brain accompanied by notable behavioural changes.It is sensible to postulate that the child is making a vain attempt "to squeeze the brain tissues" when in confusion,asthe electrical activities are disturbed.Afterall eyes are nothing butpart of brain tissue(window of the brain)Yawning,drooping of eye lids&a mild generalised hypotonia all point towards want of sleep

GENERAL DISCUSSTION:
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There is an array of differential diagnosis when a child cries.Many parents do not know that their babies will become fussy & restless now &then&mostly during 4-8 pm (pre sleeping hours)
is normal.Sothey always think that there is an abdominal colic&go running after gripe water!(because they were told that gripe water was given from the time of their great grand parents.Some people speak of SHACKEN BABY SYNDROME IF THE CHILD IS PUT ON SWINGS.In a moving car a crying or non crying child often sleepsIt shows that motion has a direct influence on the electrical activity of the motor cortex of the brain.Babies often sleep only for 30-to 60 mts,usually after afeed,when there is a slight post prandial increase in blood sugar level From 10 pm to 5 am it may wake up once or twice for feeds sake.A crying child is like a patient who will try the patience of the care giver who needs an enormous amount of forbearence.It will be out of place to discuss the various EEG abnormalities as this is not meant for doctors.Enough if the reader knows what &where is the problem SO the inability to sleep
is due to an electrical disturbance inthe brain tissue where there is constant transmission of impulses all 24 hrs.
SHAKEN BABY SYNDROME; It is a form of child abuse.Non accidental brain haemorrhage.Retinal haemorrhage(leads to blindness)These three constitute the problem.When child cries inconsolably the frustrated (psychopath)care giver looses emotional balance.Permanent brain damage, or death occurs..Symptoms:-1)irritability 2)behavioural change.3)Lithargy, sleepiness,not smiling.4)poorfeeding.5)loss of conciousness 5)vomiting 6)convulsions,7)not breathing,Many SBS victims may be undignosed vaccine inducsed encephalopathy.All vacines can produce throbocytopenia(low platlet count) causing brain haemrrhage.,most notably,Hep.B,Hib,chicken pox,MMR.Many parents have been wrongly punished &;imprisoned(in USA) for causing SBS WHEN THE CHILD UNDRGONE RECENT VACCINATION JUST PRIOR TO CLINICAL PROBLEM.This does not result from gentle swinging,uniform,whole body not involving head alone ,like shacking a coconut!.
ADVISE TO PARENTS/CREACH OWNERS/ BABY SITTERS /NANIES.
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WHEN a child CRIES AT 4-8 PM,rule out all possible common causes&;rectify.You may try all your trump cards at your hands,like singing a lul-a-by,or a soft radio music or a colourful toy which makes sound & movements.There are two donts:!)Never give a sedative 2)Never loose your temper &shake the baby's head vigorously.SOME BABIES SLEEP WHEN SWADLLED.,SOME IF AKERCHIEF IS GIVEN IN HAND.However the best would be to to embrace child in standing position(head on one side of your chest &legs on contralateral side of your abdomen)(please see photograph below). Then give a gentle rocking spiralling movement to and fro.99% babies would go to sleep. Our time tested remedy (yenai)(tamil)meaning swing is still the best remedy&there will be no shaken baby syndrome resulting .Next best is put the cuild in a car &drive. child will sleep in motion within 5-10 mts.If still the child cries drive the car to a doctor's clinic.Summery:When a child under 2 makes hyperkinetic cry the mother often looses temper.I t may be harmless in 99% cases,but should not forget hidden danger in 1% case. unless rulled out all possible cause.If one knows all the tricks of the trade child can allways be made to sleep if mother has developd a keen observation power which are specific in each child.All diferencial diagnosis discussed.Possible changes in electro encephalographic pattern ,postulated to be the cause.Dysrythmic electrical impulss causing a traffic JAM inside brain is most probable.CONCLUSION:pARENTS need not become panicky if child cries violently at 4-8 pm in the under age 2.Likefebrile fits the age & time factor is variable.Thereis no water tight compartmentment in medical matters.In the developing brain the nerve transmission of impulses takes time to settle down for full developementof condition reflexes as per individual variation enough to produce theeta activity in EEG,where child goes in to a good sleep mode.

NEWBORN SCREENING TEST:

2007-11-25T06:44:00.001-08:00

N E W B O R N --S C R E E N I N G ----T E S T S .

Introduction:
Is it a must?. There are eight important bood biochemical&electrophoretic teststhat are recomended by scientists to detectearly abnormality if any.
They areas follows:
1)Congenital hypothyroidism.
2)Galectocaemia,
3)Haemoglobinopathies
4)Phenylketonuria
5)BIOTINIDASE deficiency.
6)Congenital adrenal hyperplasia
7)cystic fibrosis
8)Maplesyrup urine disease.

The most important of all the test is the first one. T3 T4 TSH.Thyroxine is a hormone essential for all round growth &developementespesially the brain.Baby born with thyroid deficiency, will suffer from mental redardation permanently if not recognised early &treated.Treatment of all eight defects if detected is life long.A 2 Yr old with hypothyroidism will suffer from severe brain damage as the brain developement is fastest at age 2.Further developement is based on the foundations only.Even if this child is treated at age 2 till age 5 the brain developement of the 5 Yr.old will be that of 3 yr old normal childONLY.It can not catch up &will be 2-3 yrs behind allways in academic performance.

2)G A L E C T O C A E M I A:
Breast milk contains galactose(sugar)THIS CAN NOT BE SPLIT &DIGESTED by those who have no enzyme galectAse SO THERE IS unsplit galectose circulating in the blood causing a diarrheal disoder(sugar intolerance) ALL other biochemical disorders will cause all round defective growth &developement,physical motor, & mental milestones in the unfortunate children. Any question & further details can be had through my E mail Id

C E R T A I N--D O S--& D O N T S.I N I N F A N C Y:
1)Never give a purgative-including native drugs
2)DONT make anal dilatations if child does not pass (poop)FOR one day.
3)Dont yield to superstitious habits.
4)Modern medicine treatment is essential for all suspected pox lesions(fever+rash+skineruptions)
5)when child developes diarrhoea,stop all milks sweets,electrolytes.consult doctor.
6)dont resort to self medication for baby's fever.Give tepid sponging continuously &consult doctor telephonically.
7)Avoid multiple immunisations on same day even if recomended by doctor.
8)Beware of malaria at all age groups in india.Try all anti mosquito prophylaxis(remember a mosqiuto bite can cause 50,differant type of fevers--diseases!
9)Dont use seekaikai powder(soap nut powder)for scalp wash even for adults as it is the most powerful respiratoryALLERGEN&can cause severe asthma. (common practice in India)
10)NEVER FEED when baby is in lying position.(aspiration chances more)
11)measure head circumferance periodicallyupto age 5.
12)vision for refractive error&hearing test,necessary to all school children at periodic interval or if their academic performance falls below average in the class.
13)Road to health chart to be maintained in order to detect obesity earlier.(there is no more under nutrition nowadays)
14)Hare lip cleft palate babies not to be operated at birth.
15)congenital talepes equinovarus(club foot)can be treated withoutsurgery,if strapping/pop done in the neonatal stage (first week)itself.
16)Minimum polio drops requirement at age one--8doses

WHAT are the immediate health problems a new born baby may be exposed?

Medical :

jaundice.MAJORITY DUE TOphysiological if it is after day 3.or due to blood group incompatibility(Rh negative mother&Rh positive babyif it is within 24 hrs after birth.
2)Anaemia .Occurs due to any cause that destroys R B CS or due to maternal or foetal blood loss.
3)Fits.Usually neonatal tetanus.Other cause like intracranial haemorrhage,or metabolic disorders& infection.
4)Meconium ileus syndrome.Can be managed medically&sometimes surgically.There is severe obstruction due to jamming of gum like meconium inside the bowels. child may maynot pass meconium+vomiting

5)Not passing urine stools in the first 24-48 hrs.

6)Anorectal anamaly. If there is no anus surgery is the treatment of choice,after x-ray in the judgement of solomen's position(upside down)
7)Bleeding tendency.skin,/nose/gum/lungs/other sites,due to coagulation defect (FACTOR
defficiency/platlets defficiency.
8)Breast engorgement:Can occur inboth sexes,duetomaternal estrogen circulaating in neonate's
blood.Village vaidhyas&grand p arents usually squeeze it &take the "milk" out of it.There were many instances of development of septicaemias& deathdue to this practice.
9)beedding P. V .--DUE TO maternal estrogen circulation.Treatment:Leave it alone.
10)congenital heart disease. cyanotic (blue baby) Needs surgery.Acyanotics also needsurgery
often.mortality &morbidity high.Parental management is diffcult.

NEONATAL SURGICAL PROBLEMS.
1)HARE-LIP,CLEFT PALATE-maxillo facial/plasticsurgery.
tracheo esophagial fistula
3)ddiaphramatic hernia.
4congenital hypertrophic pyloric stenosis
5)Meconium ileus syndrome.
6)anorectal anamaly
7)spinbifida--Meningo-myelocele
8)Ventriculo peritonealshunt surgeryfor hydro cephalus.

CHILD RAISING ADVICES OFFERED BY ME

2007-11-24T07:39:00.000-08:00

Following child raising advices given to parents exclusivelyduring special clinics(2-4PM) 1)Infant feeding.2)SUCESSFUL PARENTING.3)All immunisation procedures.4)How to make the child to sleep.5)When to refer a case to doctor.6)what is a medical emergency?.7)How toimprove intellectual performance.8)How to detect deficiency in special senses.9)what are the routine blood check ups,in a normal child.10)How to bring a mentally retareded child.11)HOW TO IMPROVE ACADEMIC PERFORMANCE &SCORE MORE MARKS.12)hOW TO MAKE CHILDREN GET RID OF SCHOOL FEAR?13)How to correct childrens loss of memory.14)How to to enforce decipline in children.

How to Avoid the Evils of Trans Fats

2007-11-19T10:46:00.000-08:00

Beware trans fats! If you've heard the warning but aren't sure what you're supposed to do about it, here are answers:

What are trans fats?

Trans fats are unsaturated fatty acids that have been transformed to a more saturated state through a process called hydrogenation. Manufacturers add hydrogen molecules to the unsaturated fatty acids in liquid vegetable oils to make the oil more solid and increase the shelf life of certain foods.

Why all the fuss?

Trans fat acts much like saturated fat in the body – maybe worse. Studies have shown that consuming trans fat:

Increases LDL-cholesterol – that's the bad type of cholesterol that causes plaque deposits in the arteries and ultimately increases risk of cardiovascular disease. Trans fat consumption also reduces the particle size of the LDL molecules, making them more damaging to the arteries.
Decreases HDL-cholesterol – that's the good type of cholesterol.
Promotes the inflammatory response – this is an overstimulation of the immune system that has been implicated in heart disease, stroke, diabetes, and other chronic conditions.
May increase risk of diabetes - there is scientific evidence which suggests that trans fat consumption can lead to insulin resistance and ultimately increase your risk of developing type-2 diabetes.

How much trans fat is too much?

From a nutritional standpoint, trans fatsprovide no apparent benefit and can be potentially harmful. The American Heart Association recommends that trans fat consumption be less than 1% of total daily calories (about 2 grams a day if based on a 2000 calorie per day diet), but optimally trans fats should be completely avoided.

3 tips to knock toxic trans fat out of your life:

Read nutrition labels and stick to products that say they have zero grams of trans fat. Then check the ingredients; if you notice "partially hydrogenated oil" listed, put the product back on the shelf. These products may have up to .5 grams (FDA allows a product to say zero grams if it contains .5 or less). If you must buy a product with hydrogenated oil, be extra careful to only eat one serving – eat multiple portions and you're consuming more trans fat.

Use olive or canola oil when cooking at home rather than stick margarine.

When dining out, avoid fried foods.

Servicers Offered:

2007-11-18T10:27:00.000-08:00

Medical consultaion for children at my clinic at Koyemded, Chennai. (For contact information pls refer to my profile)

24 hour service available for pre-registered families

Immunization for children and adults

Special shots(vaccinations) for precious babies.

General medicine consultation for adults.

Special advice on diet for high B.P, Diabetes, heart ailments and obesity

All investigation facilities like blood , E.C.G, C.T Scan, USG Abdomen at lightening speed.

Health insurance scheme facilities.

In-house visit available.

Photograps of rare and interesting cases treated and cured by me.

Special experience in newborn babies and low birth weight babies.

Many child raising advices given like :

All About Myself

2007-11-18T07:56:00.000-08:00

DR.P.SELVARAJ

MBBS-1965,

DCH-1972,

MD(PEDIATRICS)1975.

FRSH.(London)1979.

Childhood Achievements:

First prize - all india level drawing competition for under 12 year old children. Signed by president of india Dr.Rajendra Prasad, 1951.
Proficient in ring tennis champ; athelitics district level junior champion over 20 winner certificates.
English oratorical contest - firstprize while in fourth form, for the students of IV, V, VI forms.
First prize - Tamil manavar mandram exam.
Madras Medical College - Volleyball team captain, and Madras University Player.
Boy Scout in school& sreved as security to Mr Jawaharlal nehru; NNC cadet in Madras Medical College(Earned C Certificate).

PROFESSIONAL EXPERIANCE.

IndianARMY-6yrs.civil service-10yrs.MALAYSIAN MEDICALSERVICE(Professor)3yrs

PRIVATE-23 YRS--Total-42years.Served in major 600bed hospitals(CSIHOSPITAL)

VIJAYA,M I O T HOSPITALS AS Headof the department.Contributed over 30 articles in

medical literature.

Titles of some of my papers published.

1)Congenital malaria in twins

2)meningoencephalomeyelocele

3)Asphyxiating thoracic dystrophy with polydactyly syndrome.

4)Nursery epidemics-newconcept in prophylactic management.

5)Tetanus Neonatorum-unusual presentation

6)Bulbar polio myelitis

7)Agressive rehydration,in very severe dehydration over 20% with double venesection

(sucessfully treated 20 cases conecutively)

8)NEW MANAGEMENT OF LBW BABIES IN NON ICU SETUP.

9)Neonatal resussitation 100% sucess -New approach.,in severely ill patients in a district hospital set up.

10)use of beclamethasone inhaler in neonates.

12)blood transfusion in suspected septicaemia

13)Immunisation -comments on todays practice(vaccine induced encephalopathies)

14)POISONOUS SNAKE BITES management with new concept.

15)Rabies-identification early ;prophylaxis.

16)rabies presented as status asthmaticus.

17)MECONIUM ILEUS SYNDROME-decieving presentation

18)NEWborn-examination for beginers.

19)NEONATAL sugar intolerance.

20)ORS in pediatrics(inter national journal of medicicinetoday)2oo7

21)cranial cysticercosis in peadiatrics.

22)'Osgood Shlatter' disease

23)'4 to 8 PM Syndrome'OR Sleep disturbed baby syndome in peadiatrics (Under publication).

Special Government Training courses attended :(G.H. Chennai)

1. Blood transfusion (King institue guindy chennai).

2.Family planning operations

Passed account test for executive officers.(govt.exam)

Pariticipation in conferences :

1.Indian Academy of Pediatrics conference ; won awards

2.Various symposia debates conferences held by Indian medical Association

3.Atrial septal operation for cardio myopathy (only one &; world's first of its kind , conducted on MR.Murasoli Maran Minister, Central Govt India at Appollo hospital Chennai.)

4.Ultra sonology training course conducted by IMA, CMC Vellore.

5.Delivered lectures to doctors through indian medical association.