June 2020 - CHILD AND CHEST HEALTH CARE

Asthma may be protective against COVID 19,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Sahibabad,Ghaziabad,Delhi-NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 26 Jun, 2020 - Professionals Guide, - 0 Comment

It is a common perception among doctors and public that, asthma may predispose to severe form of Corona Virus Disease 2019(COVID 19).

Corona Virus infects primarily the respiratory tract and Asthma is the most common chronic disease of respiratory tract worldwide.

The primary symptoms of Asthma are cough and breathlessness ,which are also the symptoms of Corona Virus Disease 2019.

Asthma is an allergic disease of airway in most of the cases in children ,whereas COVID 19 is an infective disease.

Viruses,chiefly Rhinovirus and Respiratory Syncytial Virus(RSV) are the trigger factors for asthma exacerbation.

So,it is presumed that Corona Virus can also trigger asthma and both may cause serious condition.

Since the airway epithelium and leucocytes of persons suffering from asthma have impaired production of antiviral interferons(Interferon alpha,beta,gamma),due either to allergic inflammations or primarily,it was presumed that the innate immunity of these individuals can not check the viral infections from travelling to lower respiratory tract form upper respiratory tract.

Literature search from 8 studies,comprising more than 17ooo individuals form different geographical areas revealed that the prevalance of COVID 19 was low in areas where prevalance of asthma was high .In persons having comorbidities like Diabetes Mallitus and COPD,Corona Virus infection caused severe infections which was not seen in comorbidities like Asthma.

According to a research,it has been found that 2 host molecules are important for severe acute respiratory syndrome corovirus 2(SARS COV 2).Corona Virus uses ACE 2 receptor (angiotensin converting enzyme 2 receptor) to enter the cell and transmembrane serine protease for priming of S protein of the virus.

In vitro treatment of epithelial cells with interferons increased the expression of ACE 2 receptor.

The high level of interleukin 13 and T2 cytokines downregulate the expression of ACE2 in epithelial cells.

Asthmatic individuals have high levels of T2 cytokines and interleukin 13.

Bronchial epithelium of asthmatic individuals have low expression of ACE2 receptor as compared to general population,whereas persons having severe form of COVID 19 show high level of interferon.

Researchers concluded that Asthma may be a protective factor for COVID 19 as asthmatic respiratory epithelium shows low expression of ACE2 receptor.

The study is published in Journal of Allergy and clinical immunology.

REFERENCES:

1.Matsumoto K, Saito H. Does asthma affect morbidity or severity of Covid-19? [published online May 26, 2020]. Editorial. J Allergy Clin Immunol. doi:10.1016/j.jaci.2020.05.017

2. Zheng X-y, Xu Y-j, Guan W-j, Lin L-f. Regional, age and respiratory-secretion-specific prevalence of respiratory viruses associated with asthma exacerbation: a literature review. Arch Virol. 2018;163(4):845-853.

3. Edwards MR, Strong K, Cameron A, Walton RP, Jackson DJ, Johnston SL.Viral infections in allergy and immunology: How allergic inflammation influences viral infections and illness. J Allergy Clin Immunol. 2017;140(4):909-920.

4. Li X, Xu S, Yu M, et al. Risk factors for severity and mortality in adult COVID-19 patients in Wuhan [published online April 12, 2020]. J Allergy Clin Immunol. doi:10.1016/j.jaci.2020.04.006.

5. Singer AJ, Morley EJ, Meyers K, et al. Cohort of 4404 persons under investigation for COVID-19 in a NY hospital and predictors of ICU care and ventilation [published online May 11, 2020]. Ann Emerg Med. doi:10.1016/j.annemergmed.2020.05.011

6. Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181(2):271-280.e8.

Children display different symptoms in comparision to adults ,of COVID 19,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Sahibabad,Delhi-NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 17 Jun, 2020 - Professionals Guide, - 0 Comment

According to a systematic literature riview,it was found that children have not the same sets of symptoms as adults when they get infected to novel Corona Virus,SARS Cov 2, responsible for Coronavirus disease 2019(COVID19).

The study included clinical,pathological and radiological features.

Researchers included 38 studies comprisisng 1124 cases.They found that about 14 percent children infected with Novel Corona Virus did not exhibit any symptom and they were asymptomatic. About 36 percent were having mild symptoms.,about 46 percent displayed moderate symptoms ,about 2 percent were severly symptomatic while about 1 percent children were critically ill.

The most common symptom was fever which was seen in about 47% of cases,followed by cough which was present in about 41% of cases. Nasal symptoms were seen in about 11% of cases whereas dairrhoea was seen in about 8% cases.

Nausea and vomiting were present in about 7 % of cases and about 37% children developed Pneumonia.About 11% children were diagnosed as upper respiratory tract infections due to Corona Virus.

About 1 in 10 children showed lymphopenia whic is very common in adults.63% children had findings on CECT Chest including ground glass appearance,patchy opacities and consolidation.

There was only 1 death in this systematic review of literature

Fever and cough should not be considered as a hallmark of COVID 19 in children.Pediatrician should keep a high index of suspician to diagnose COVID 19.

Most of the children have favourable outcome after getting infected with novel Corona Virus

child with COVID 19 REFERENCES;Pediatrc Pulmonology,online publication,June 2020

Famotidine is a promising drug to treat COVID19,Dr.D.k.JHA,M.D.,

DR DEV KUMAR JHA - 16 Jun, 2020 - Respiratory, - 0 Comment

Famotidine is H2 receptor antagonist which is out of fashion now,which has been widely used to treat gastritis in children as well as in adults.

According to a case series of 10 patients of COVID19, Famotidine was self administered at home as it is a over the counter drug,means anyone can purchase it from medical store without the prescription of a doctor.

The dose used was 80 mg three times daily for a median period of 11 days.

Patients were interviewed on telephone regarding ,demography,risk factors,temperature,oxygen saturation and general well being apart from commom symptoms related to COVID 19.

According to the National institute of health protocol,longitudinal severity scores of 5 symptoms were collected-headache,cough,fatigue,shortness of breath and ansomnia.

The demography and risk factors were wide in the patients.Symptomps started to improve after 24-48 hours of initiation of therapy and the patients came to premorbid condition 14 days after treatment.

Particularly airway related symptoms like cough and shortness of breath improved faster than general symptom like fatigue

The mechanism of action of this drug Famotidine has not been established,which needs further study.

REFERENCES:Janowitz T, Gablenz E, Pattinson D, et al. Famotidine use and quantitative symptom tracking for COVID-19 in non-hospitalised patients: a case series [published online June 4, 2020]. Gut. doi:10.1136/gutjnl-2020-321852

Concern of Parents in care of New Born,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Sahibabad,Delhi-NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 15 Jun, 2020 - Child Health Guides,Parents’ Guide, - 0 Comment

As soon as the baby has been given to you after delivery,the baby should be covered in dry cloths.

The baby should be covered fully,specially head cap should be put on,and hands and feet should be kept covered.

The head ,hands and feet should be warm to touch and face should be kept open so that the baby can be visible and the baby can breathe easily.

Breast feed should be established within 1/2 to 1 hour of delivery even in Caesarean delivery.

The amount of breast milk is less during first 3 days of delivery and it it thicker,but it is sufficient for the baby.

Usually the feed should be on demand ,indicated by cry of the baby.

In general a baby should be fed 2-3 hourly.

If the milk is coming less,do not worry,just continue feeding the baby and keep your diet healthy,certainly the milk will be sufficient.

If you feed more ,more milk will come,if you feed less,less milk will come and if you will not feed the baby, no milk will come.

Nothing other than breast milk should be given to baby starting from just after the birth upto the age of 6 months.

Even water should not be given till 6 months of age unless medically required.

The head and chest of baby should be slightly elevated while feeding.

Just after feeding,take the baby on shoulder and pat on the back for few times ,then make the baby lie on bed keeping the head end slightly elevated.

Normally the baby passes stool and urine within 24 hours of delivery.

WARNING:If the baby does not pass stool within 24 hours of delivery and urine within 48 hours of delivery,consult your doctor.

A newborn passes black stool for initial 3 days, then the colour gradually changes to greenish-yellow then yellow.

A newborn passes stool 6-8 times and passes urine 12-14 times in 24 hours.

The stool frequency gradually decreases in next 6 months.

A newborn should not be given deep bath till the fall of umbilical cord stump which takes 6-10 days in usual cicumstances.

Till then, sponging with clean water should be done.

WARNING:Nothing should be applied over the umbilical cord stump.Sometimes,surgical spirit or betadine can be applied under supervision of a doctor.Consult your doctor if there is any discharge from the umbilical cord.

Oil massage should be done usually after 15 days of birth.

A newborn usually sleeps for 16-18 hours in 24 hours,so do not worry if your baby is sleeping most of the time.

WARNING:Consult your doctor if your child is sleepy and refuges to feed or taking less feed. Never feed your child or never give any medicine when the child is in lying position.Always put the baby in lap with head and chest slightly elevated while feeding or giving medicine.

Positve test result after recovery from COVID19 is harmless,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Sahibabad,Delhi-NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 11 Jun, 2020 - Professionals Guide, - 0 Comment

It is a cause of worry for many patients including health care workers to receive positive test result for Corona Virus even weeks to months after they have recovered fully.

They are confused and their employers are more confused whether they should join their duties or not.

Mothers are more worried after recovery from disease ,when they should kiss their babies if test report is still positive.

RT-PCR test being used to diagnose Corona Virus Disease 2019 ,detects the pieces of RNA of virus.It can not differentiate between active and dead virus.So,this test is useful for the diagnosis of disease but not for the recovery from the disease.

There is a study of 9 patients suffering from COVID 19,in Germany.They put the sample after 8 days of onset of disease,into the culture.There was no growth of virus in the culture.Moreover,there was no yield of subgenomic mRNA.These both are indicators of live virus which can infect others and capable of producing disease.It was concluded that if the number of Virus is less than 10000/ml of Sputum,it can not cause the disease..The study was published in NATURE

Resarchers from South Korea,centre for disease control, traced 285 patients who became negative and their isolation was terminated.They again became positive but non of them could transmit the disease to anyone even after converting to positive test result again.

According to the CDC guideline ,a patient is labelled negative only after 2 consequitive test results are negative,keeping in view so many false negative results.

But now it is a fact that some patients may remain positive months after the recovery from COVID 19.

On the other hand,some patients may become positive again after becoming negative.

These patients do not transmit virus that can cause disease to others.

REFERENCES;Doctors Wonder What to Do When Recovered COVID-19 Patients Still Test Positive – Medscape – Jun 09, 2020.

Coronavirus Encephalitis,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Sahibabad,Delhi-NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 10 Jun, 2020 - Professionals Guide, - 0 Comment

Coronavirus disease 2019(COVID 19) is considered primarily a respiratory disease.

Symptoms of respiratory infections usually seen in COVID 19 are fever,cough,sore throat,malaise,and breathlessness. .

Patients may present as a case of pneumonia ,ARDS,Shock or MODS.

Some patients may develop pain abdomen,vomiting and diarrhoea

Some patients may present as a case of meningitis,encephalitis or meningoencephalitis.

According to a study of case series of 3 cases,all presented with features of CNS infection,CSF examination were normal in 2 cases.

PCR test on CSF were also negative.

After the negative test result of PCR,it was thought that,the encephalitis was not due to Corona virus.

But all three cases were diagnosed as corona virus encephalitis,only when IgM antibody test against novel Corona Virus came positive.

It is being analysed that the PCR test is good for Herpes virus but not for Corona Virus.

One patient also develpod encephalomyelitis(inflammation of brain and spinal cord).

So,it has been concluded that ,only antibody test in CSF,can diagnose encephalitis due to novel Corona Virus.

REFERENCES:Pauline Anderson. Does CSF Antibody Testing Confirm Coronavirus in the Brain? – Medscape – Jun 08, 2020.

Thumb sucking in children,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Sahibabad,Delhi-NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 09 Jun, 2020 - Child Health Guides,Parents’ Guide, - 0 Comment

Thumb sucking is frequently seen in infants and children.

It is not a disease but a habit in some children.

It is a cause of undue disturbance in parents.

It does not cause any problem in children below 4 years of age.

CAUSES:Some children starts sucking thumb when they are hungry.
Some children starts sucking thumb when they feel lonliness.
Some children starts sucking thumb just to induce sleep.

It is very common phenomenon in children at the time of teething to start sucking their thumb to pacify themselves when they feel irritation in gums.This is the same time some parents prefer to give some form of pacifier to their babies.

This phenomenon is harmless in babies as long as they just put their thumb into their mouth and start sucking gently.It becomes harmful if they vigorously suck their thumb or fingers because it may then cause disfigurement of mouth,roof of mouth or teeth.

This phenomenon of thumb sucking is very common in children below 3 years of age and in usual cases, it vanishes after the age of 2-4 years.

HOW TO GET RID OF IT–

:Do not try to take out the thumb or fingers from the mouth of baby, as it will worsen the problem.
Try to engage the child in some other activities.
Tell some stories to induce sleep in children
Give the child feed on time.

If these do not work,you may apply bandages or socks over the thumb .Some harmless food ingredients may be applied over the thumb like juice of NEEM or bitter gourd but under supervision of a qualified doctor and at right time and right quantity.Some doctors prefer to apply bitter medicine which are harmless to overcome this problem

REFERENCES:Mouth healthy,American Dental Association

Children with COVID19 become critically ill ,although less in comparision to adults.Dr.Dev,M.D,Pediatrician and Pediatric Pulmonologist,Sahibabad,Delhi NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 08 Jun, 2020 - Professionals Guide, - 0 Comment

Children have usually less severe illness due to COVID 19 as compared to adults but more chance of severe illness if they have develpomental or genetic anomalies.

According to one retrospective study in North America ,published inJAMA Pediatr,children having corona virus infections were divided into 4 categories

1.Mild: cough,sore throat,fever and myalgia

2.Moderate:cough,fever, sore throat and breathlessness and/or findings in chest radiograph consistent with SARS-Co-v2 pneumonia

3. Severe:cough,fever,sore throat,breathlessness with new requirement of oxygen or need of escalating the dose of oxygen if already being given with or without ventilator support

4.Critical: Children requiring mechanical ventilation,ARDS,shock,systemic inflammatory response syndrome,multiorgan failure.

A total of 48 children were included in study with a median age of 13 years. An average number of admission in PICU was, 3 admission per PICU. All children were diagnosed by examination of nasal swab.

About 50% children had one comorbidity,17% had 2 and 19% had 3 0r more comorbidities.

69% children were critically ill and 25% required vasoactive drugs.81% children required respiratory support and 38% children required mechanical ventilation.One child required ECMO.

Most common drug used was hydroxychloroquine.Other drugs being used were Azithromycin,Remdesivir,and Tocilizumab.

The overall case fatalities were 4.2%

REFERENCES:

Shekerdemian LS, Mahmood NR, Wolfe KK, et al; International COVID-19 PICU Collaborative. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. [published online May 11, 2020]. JAMA Pediatr. doi:10.1001/jamapediatrics.2020.1948.

CHILBLAIN-A MANIFESTATION OF CORONA VIRUS INFECTION,Dr.Dev,Pediatrician and Pediatric Pulmonologist,Sahibabad,Delhi-NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 04 Jun, 2020 - Professionals Guide, - 0 Comment

Childern behave differently in corona virus infections.They usually have milder forms of disease.Particularly,infants less than 12 months,are immune to the disease in most of the cases.But they can spread the disease to adults.
In two case series studied retrospectively in Spain and Italy,children have been found to have skin lesions simulating chilblains.Some developed pruritus and some pain over skin. These lesions were observed after a median period of 14 days of other symptoms like cough ,fever,pain abdomen and dirrhoea.
Biopsy from all lesions showed lymphocytis vasculitis.Serum levels of D-dimer were raised, so there were some form of coagulopathy in those cases.Children were between the age of 5-17 years.
All children required analgesics for pain relief,antihistaminics for pruritus and local application of corticosteroids.All children recovered well .So prognosis was excellent.
So, skin lesions in the form of chilblains should be kept in mind while examining a child during Corona virus epidemic

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REFERENCE:Ped Derm.Published online,May6 and May9 2020

TEETH GRINDING(Daant Kitkitaana),Dr.DEV ,Pediatrician and PediatricPulmonologist,Sahibabad,Delhi-NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 02 Jun, 2020 - Child Health Guides,Parents’ Guide, - 0 Comment

Teeth grinding which is commonly called Daant Kitkitaana in India, is very common complaint by Parents.In medical term,it is called BRUXISM.
It is a common belief in India that a child grinds his or her teeth due to worm infestations.Worm infestations is very common in India and a child with any symptom ,when investigated may be found to have worms in abdomen which may be a coincidental finding.
A child having worm infestation, grinds his or her teeth, does not has any scientific basis.Worms infestations has various presentations other than teeth grinding.
There are many causes of teeth grinding such as
1.A child having difficulty in getting onset of sleep or having disturbed sleep.
2.A child is irritated when he or she is not heard.
3.A child is feeling depressed because some of his or her requirements have not been fulfilled.
4.A child has not been fed according to his or her desire.
5.A child is suffering from some form of upper respiratory tract problems.
So, a child having teeth grinding should not be given anti worm medicines.