for diagnostic curiocity--another pediatric case

An infant one year of age stared crying spontaneously without any provocation,child's name-Raja coming from raja street chengam thiruvannamalai, referred byDr.D.Ramamurthy,25 years back child was already seen by 7doctors with multiple injections/medicines. History:-baby started crying almost continuously with a small period of interuption.No food &no sleep for more than 72 hours on  examination;-EXCEPT FOR CRY nothing abnormal noted How ever child had very high heart beatsshould be above 300 per minute.I could not come to any defiite conclusion .No investigation done. As the child was extremely restless trying to give any I.V injection was utter failure. so child was wrapped in a blanket one alone was exposedIcaught hold of the hanug efectsd &showed the vein to the nurse another nurse brought  inj.digoxin+lasix with 10 ml dilution in 24 size butter fly needle.The injection was given successfully,&blanket removed.No sedation was given as the previous doctors would have given more than enough sedation

                            I went for lunch &returned after 3--4 hours. when I could not believe my eyes.The child was laughing & playing.the heart was normal in rate &rhythm
Discussion:- The cause could not be confirmed due to want of investigation fecility.How ever following possibilities were kept in mind.1)clinically surgical possibility ruled out 2)hunger cry 3)sleeplessnes4)Acute
peri/myo/endocarditis (virus)5)Drug effects of medicines used by previous doctors.6)Insect bite like
scorpion sting(cold clamy peripheries(peripheral circulatory failure)

penicillin anaphylaxis--true story of a ressusitated case

ONE YEAR OLD  MALE CHILD BROUGHT IN AS A DEAD BODY AS THERE WAS NO HEART SOUNDS OR RESPIRATION.SAID TO HAVE DEVELOPED SUDDEN UNCONCIOUSNESS AFTER INJECTION PENICILLIN FOR RESPIRATORY INFECTION.THE DOCTOR LADY,PLASTIC SURGEON WHO BROUGHT THE CASE FLEW AWAY BEFORE I FINISHED EXAMINATION.CHILD WAS FROM TI CYCLES INDIA ARAKONAM(1977)

I SWUNG INTO ACTION.CARDIO PULMONARY RESSUSITATION STARTED LIKE A HIGH SPEED ENGINE,INJ.INTRACARDIAC ADRENALINE GIVEN FIRST.EXTERNAL CARDIAC MASSAGE GIVEN BY NURSE I INTRODUCED THE ENDOTRACHEAL TUBE &STARTED BLOWING AIR WITHOUT AMBU BAG.HIS HEART STARTED BEATING &LUGS SHOWED INSPIRATION/EXPIRATION WITH MININIMAL WEEZE(MAY BE DUE TO E-T TUBE)   TO MAINTAIN I.V.LINE SAPHENOUS VENESECTION DONE .1)ISOLYTE P DRIP WITH INJ DERIPHYLINE,&DECADRON PLUS ANTIBIOTIC GIVEN ORALLY(TETRACYCLINE).CHILD STAYED IN THE HOS PITAL FOR ONE DAY OBSERVATION&DISCHARGED IN FIT CONDITION AFTER TWO TRIAL ORAL FEEDS.NO NEWS HEARD FROM THE TI CYCLES DOCTOR! GOD IS GREAT,I HAVE NOT HEARD OF ANY PATIENT SURVIVING AFTER CARDIO-PULMONARY RESSUSITATION.

A CASE FOR DIGNOSTIC CURIOCITY-----NEWBORN BABY.

THIS IS THE STORY OF A JUST BORN BABY OF 4 HOURS OF AGE.FEMALE CHILD NAMED
KHUSHBU.BORN NORMAL WITH APGAR SCORE10/10 AT 5 MINUTES.(DELIVERY AT CSI HOSPITAL ERODE).I DID THE NEONATAL RESUSSITATION.WARD SISTER CALLED ME TO SEE THE CASE AS THE CHILD IS DEVELOPING CYANOSIS(BLUE COLOUR).AS THE CHILD WAS EXTREMELY PINK, BLUE COLOUR WAS VERY OBVIOUS(RAJASTHANI)'

I EXAMINED THE CHILD THOUROUGHLY &COULD NOT COME TO ANY CONCLUSION.IN THE MEAN TIME THE CYANOSIS IS SLOWLY GOING FROM PERIPHERY TO CENTER.IN THOSE DAYS THERE WAS NO PULSE OXYMETER 25 YEARS BACK.I CALLED THE PEDIATRIC SURGEON &ANAESTHETIST TO EXAMINE TO GIVE THEIR OPENION.THEY COULD NOT CONTRIBUTE ANY THING FOR ME TO PROCEED FURTHER.CHEST WAS CLINICALLY NORMAL&X RAY CHEST WAS ALSO NORMAL I WAS IN A DIALEMA WHETHER THIS IS A MEDICAL OR SURGICAL CASE..IN MEDICINE "FIND OUT THE CAUSE & TREAT THE CAUSE" IS THE GENERAL  PRINCIPLE.IN THIS CASE I TREATED THE CASE FIRST &MADE A RETROSPECTIVE DIAGNOSIS!

I PUT IN A FINE POLYTHENE CATHETER INTO THE TRACHEA &RIGHT MAIN BRONCHUS THROUGH AN ENDOTRATRACHEAL INTUBATIONWITH LARYNGOSCOPE..I CONNECTED THE OUTER END OF CATHETER TO BECLAMETHASONE INHALER IN AN IMPROVISED METHOD &PRESSED THE INHALER WHILE I ASKED THE NURSE TO SQUEEZE THE CHEST  OF THE BABY AS SHE DID NOT DO IT WELL ,I DID CHEST COMPRESSION ASKING HER TO PRESS INHALER ON MY COMMAND. IN ABOUT 20 MINUTES THE MIRACLE HAPPENED.
THE BABY BECAME 100% PINK THEN WE REMOVED THE TUBES THE BABY WAS FINE.
ON QUESTIONING THE MOTHER  THE HISTORY WAS SPINE CHILLING.THEY HAVE GIVEN THE CHILD "THULASI WATER FROM TEMPLE& THAT GOT ASPIRATED(CHOKING).JUST ONE DROP IF ASPIRATED COULD KILL THE CHILD.LUCHILY THE CHILD'S TRACHEAWAS SUCKED OUT NICELY BY A MACHINE PRIOR TO INTUBATION PROCEDURE

DIAGNOSIS;--ASPIRATION BY THULASI WATER
DISCUSSION;--THE MINIMAL ASPIRATION IN A 2 HOURS OLD BABY HAD PRODUCED SEVERE BRONCHOSPASM INTERFERING WITH ITS PULMONATY OXYGEN- CO2 DISSOSIATION .BECLAMETHASONE HAS PRODUCED ENOUGH BRONCHODILATATION&PRODUCED A CLINICAL CURE  APPLICATION OF MACHINE SUCTION HAS SUPPORTED THE PROCEDURE.

HOW DOES BRAIN FUNCTION-NORMALLY

WHAT IS BRAIN?

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

THIS IS A BUNDLE OF COLLECTION OF ELECTRICAL WIRES COMPOSED OF NEURONAL TISSUES,VERY COMPLEXLY INTERCONNECTED TO VARIOUS ORGANS &WITHIN ITSELF

&OWEN LKE A SWEATER, MILLION TIME MORE COMPLICATED.

2)HUNDRED &THOUSANDS OF NEURONS FUNCTION WITH OTHER NEURONS THROUGH INTER CONNECTIVITY.

3)THEY PRODUCE ELECTICITY CONSTANTLY

4)THEY TRANSMIT IMPULSES  TO DESIRED DESTINATIONS.THE NUEROTRANSMITTERS ACT LIKE CATALYST FOR FINAL TRANSMISSION OF IMPULSES AT TARGET LEVEL

5)DIFFERENT NEURONES
 DO THEIR FUNCTIONS INDEPENDANTLY &COORDINATE WITH OTHER FUNCTIONS TO ACHIEVE FINAL ACCOMPLISHMENT OF DESIRED WORK.

6)SOME FUNCTIONS ARE ,MOTOR,/SENSORY/EMOTIONAL/REFLEX

7)TO ACHIEVE THIS NORMAL SCORE NEURO ANATOMY,PHYSIOLOGY,&BIOCHEMISTRY,A GOOD BLOOD SUPPLY IS ESENTIAL& SHOULD BE PROVIDED AS SOON AS BIRTH OCCURS WITHIN 10-20 MINUTES(APGAR

SCORE DESIRED IS 10/10)

PATHO-PHYSIOLOGY

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

ALL BRAIN BLOOD VESSELS ARE NOT OPEN AT BIRTH.MANY ARE NOT PATANT.THEIR 

PATENCY IS OPENED ,BY INCREASE IN BLOOD PRESSURE DUE TO NEONATAL .LUXURIOUS CRY. ,RESULTING IN VARIOUS  GOOD CONNECTIVITY.  ABSCENCE OF SUCH CRY CAN CAUSE SIGNIFICANT DIFFICIENCY RESULTING IN VARIOUS DISABILITY OF WHICH

AUTISM IS VERY IMPORATANT(CONCEPT STESSED BY THIS AUTHER)

ROLE OF NEUROTRANSMITTERS.

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SEROTONIN

---------------- SECRETION RESPONDS TO SENSORY INPUTS RECIEVED BY ALL 5 SPECIAL SENSES.

DOPAMINE:--TOO MUCH DOPAMINE SECRETION AFFECT EMOTIONAL STATE,ABILITY TO CONCENTRATE &ABILITY TO LEARN

GABA --PREVENTS OTHER AREA OF THE BRAIN FROM OVER STIMULATED BY BALANCING OTHER TRANSMITTERS

AUTISM-CAUSES

1)GENETIC--5-20 GENES AS CLUSTER GROUP
2)HYPER IMMUNE STATE
3)FRESH COW'S MILK(NOT IN FORMULA TINNED POWDER)
4)DRUGS TO ANTINATAL MOTHERS
5)ALL VACCINES FROM BIRTH-3 YEARS--SPECIALLY DPT CONTAINS ALUMINIUM
ALSO IMMUNOGLOBULIN MEDIATED ADVERSE REACTON
MULTIPLE VACCINES ON SAME DAY-SOME PRODUCE PLATLET DEFICIENCT CAUSING INTRA CRANIAL HAEMORRHAGE,LEADING TO NUERONAL DAMAGE

6) ANY DAIRY PRODUCT
7)GLUTEN--A PROTIEN CONTAINED IN WHEAT
8)IMPAIRED CORTICAL ACTIVITY--CONGENITAL/AQUIRED
9)FAILURE OF FUNCTION OF FOLLOWING COGNITIVE AREAS OF THE BRAIN
a)LANGUAGE COMPREHENSION
b)VISUO SPATIALPROCESSING
c)SOCIAL COGNITION
d)EXECUTIVE FUNGTIONING
11)DIFFERENT GUT FLORA(URINARY METABOLIC PHENOTYPING)
12)IRREGULAR WHITE MATTER TRACT LEADING TO REDUCED ANATOMICAL CONNECTIVITY OR FUNCTIONAL UNDER CONNECTIVITY WHICH MAY BE CONGENITAL OR AQUIRED.
13)INCREASED SIZE OF AMYGDALA,AROUND AGE ONE YEAR DISRUPTING CONECTIVITY(DIAGNOSIS BY FMRI)
14)ANOXIC BRAIN DAMAGE AT ANY AGE SPECIALLY DURING IMPROPER NEONATAL RESUSSITATION

NEONATAL RESUSSITATION--AUTHER'S STATISTICS

THE FOLLOWING ETIOLOGICAL FACTORS WERE ENCOUNTERED  FOR NEONATAL RESUSSITATION DURING A 5YEAR STUDY:--

CAUSE                                                        NO.OF CASES             PERCENTAGE
1)FOETAL DISTRESS
UNCASSIFIED                                           144                                 18.23
2)LSCS                                                         140                                 17.72
3)DIFFICULT LABOUR
PROLONGED PERINATAL PERIOD           72                                   9.11
4)EARLY RUPTURE OF MEMBRANE         64                                   8.10
5)PRETERMS                                                 144                                  18.23
6)CORD AROUND NECK                             62                                      7.8
7)AMNIOTIC FLUID ASPIRATION               40                                      5.06
8)BIG BABIES                                                   36                                     4.55
9)MECONIUM ASPIRATION                           30                                     3.79
10)LBW                                                               12                                     1.5
11)HAND PROLAPSE                                        16                                      2.02
12)CORD PROLAPSE                                         12                                      1.5
13)SHOULDER PRESENTATION                        6                                       0.75
14)BREACH(VAGINAL DELIVERY)                   6                                        0.75
15)TRANSVERSE LIE                                          6                                        0.75
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SHOWING THERAPEUTIC EFFICACY OF RESUSSITATION TECHNIQUE


TACTILE STIMULATION                                  461                                     59.0
TRACHEAL SUCCTION                                    188                                     23.5
DRUG STIMULATION                                        141                                     17.5
TOTAL                                                                  790                                      1OO SUCCESS RATE                          

AUTISM--MOTOR EXERCISE FOR MOUTH& PHARYNX /STIMULATE SENSATIONS

AS THERE WILL BE ATLEAST A MINIMAL HYPOTONIA IN MAJORITY CASES , PHYSIOTHERAPY SHOULD BE GIVEN TO THE ENTIRE BODY /UPPER &LOWER EXTRIMITY

BESIDES CHILD MUST DO THE FOLLOWING

1)CHEWING MOVEMENTS  2)SWALLOWING MOVEMENTS 3)BLOWING AIR(BALOON WITH A TUBULAR STICK) 4)BLOCK CHILD'S NOSE--ALLOW TO BREATH THROUGH MOUTH 5)BLOCK MOUTH--ALLOW TO BREATH THROUGH NOSE.

ALL THE ABOVE  HELPS THE CHILD TO SWALLOW BETTER & FOR BETTER PHONATION

TO STIMULATE SENSORY SYSTEM

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POUR HOT WATER &COLD WATER ALTERNATIVELY ON LOWER &UPPER LIMBS FOR 

5 MINUTES IN THE MORNING &EVENING DAILY