2020 - Page 2 of 7 - CHILD AND CHEST HEALTH CARE

Ground glass opacity in CT Chest,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 - 04 Aug, 2020 - Professionals Guide, - 0 Comment

The most common imaging technique to diagnose a chest contion is Chest X-Ray.

Chest X-Ray has low sensitivity to diagnose a lesion of chest ,particulalry parenchyma of lungs.

CT Chest ,although gives a high dose of radiation which is harmful particularly for a growing lung of child,is sometimes required to diagnose a chest condtion with more accuracy.

There are so many defined opacities seen on CECT or HRCT chest which gives diagnostic clues.

Ground glass opacities are one of them.

In the time of many cases of Pneumonia due to Corona Virus Disease 2019,it has been observed that the typical findings seen on CECT/HRCT Chest is ground glass opacities(GGO) seen in the periphery of lungs at subpleural locations and in the lower lobes of lungs bilaterally. Later on there may be crazy-pavy pattern,architectural distortion and perilobular opacities superimposed on GGO.There may be bilateral subpleural and lower lobe consolidation. .Atypically, a patient of COVID 19 pneumonia may have upper lobe and peribronchovascular distribution of GGO,cavitations ,pleural thickening, and lymphadenopathy.

It is very dificult to differentiate these lesions typical of COVID19,from other viral pneumonia as approximately 75% of Adenovirus pneumonia and more than 75% of cytomegalovirus and Herpes simplex virus Pneumonia have GGO on chest CT.Approximately 25% of Pneumonia due to Human Metapneumovirus has GGO on chest CT.

ILD(Interstitial lung disease) also shows GGO on chest CT.GGO is commonly seen in Pneumocystis carini Pneumonia but in such cases it is predominantly seen on upper lobes.

GGO is commonly seen in eosinophilic pneumonia,pulmonary edema,alveolar hemorrhage,hypersesitivity pneumonitis ,pulmanary alveolar proteinisis and lung injury due to vaping and use of electronic cigarettes.

These may be differentiated by clinical pictures.

Bacterial pneumonia may be differentiated from viral Pneumonia as the opacity has focal lobar,segmental,and sunsegmental distribution usually not predominantly in the lower lobes..It may be further differentiated by the presence of cavity.lung abscess and lymphadenopathy

REFERENCES:https://bit.ly/3exnOFJ Radiology, online July 7, 2020.

Mavrilimubab,may save patients with severe COVID 19 Pneumonia,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 - 03 Aug, 2020 - Professionals Guide, - 0 Comment

It has been observed that the death due to COVID 19 infections is secondary to severe Pneumonia and systemic hyperinflammation.

Severe Pneumonia is a condition of Pneumonia, when support to the respiratory system is needed for its proper functioning.

Respiratory support may be in the form of oxygen inhalation or mechanical ventilation,invasive or non-invasive.

Systemic hyperinflammation is a state in which there is secretion of cytokines in huge amount,called cytokine storm.

These both conditions,severe Pneumonia and hyperinflammatory state carry highn mortality.

MAVRILIMUBAB is Granulocyte-monocyte colony stimulatinfg factor -receptor alpha ,monoclonal antibody with ability to check cytokine storm.

In a study at Italy,which is published in Lancet,authors studied on 39 patients who were non mechanically ventilated.They gave mavrilimubab intravenously to 13 patients in the dose of 6 mg/kg(single dose),in addition to standard care for Pneumonia. 24 patients received standard care for pneumonia and they acted as control.

8% patients in study group, progressed to mechanical ventilation as compared to 35% in control group(p=0.14)

During the follow up period of 28 days,non of the patients died in study group ,whereas 27% patients died in control group(p=0.086).

All patients (100%) showed clinical improvement in study group as compared to 65% in control group(p=0.03).Improvement was earlier in study group as compared to control group(p=0.0001).Fever control was faster in study group as compared to control group(p=0.0093).

Mavrilimubab was well tolerated with no infusion reaction,whereas 12% of control group developed infectious complications.

Study was done between March 15 and April 17,2020

SO,Mavrilimubab may be life saving in severe Pneumonia due to COVID19 and syudy on large sample is needed before its recommendation

REFERENCES;

De Luca G, Cavalli G, Campochiaro C, et al. GM-CSF blockade with mavrilimumab in severe COVID-19 pneumonia and systemic hyperinflammation: a single-centre, prospective cohort study [published online June 16, 2020]. Lancet Rheumatol. doi:10.1016/S2665-9913(20)30170-3

TOPICS: COVID19 LUNG INFECTIONS PNEUMONIA
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Ibuprofen is safe to use during 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 - 27 Jul, 2020 - Professionals Guide, - 0 Comment

There is no specific treatment available for COVID 19,all over the world.

In such case, the only treatment which can be useful is the symptomatic treatment.

The troublesome symptoms which need to be addressed are ,fever,headache and bodyache apart from cough

The most widely used drug to get relief from fever and pain is paracetamol and acetaminophen derivatives.

Some people do not feel comfortable even after taking Paracetamol and continue to feel headache ,bodyache,and fever.

These cohort of people get relief after taking Ibuprofen.

It was believed at the outset of epidemic of COVID 19,that the use of Ibuprofen may worsen the severity of COVID 19 and people refrained from using this drug.

Researchers from Israel studied the effects of Ibuprofen in patients of COVID 19.They studied 403 patients with the median age of 45 years.They observed the patients from 1 week prior to the diagnosis to,throughout the course of disease.

44% patients developed fever who required its treatment.32% patients used Acetaminophen and 22% used paracetamol to treat their fever.

Respiratory support was needed in 11% patients in Acetaminophen group and approximately10% in Ibuprofen group(P=1).

Mortality was noticed in 2.4% patients using Acetaminophen and 3.8% using Ibuprofen(P=0.95)

So,there was no difference observed between Acetaminophen group and Ibuprofen group as far as the need for respiratory support or mortality are concerned

Although there are many limitations of this study including recall bias and no study among asymptomatic patients,this is an important study which needs further study on larger population before making a general opinion.

REFERENCES;

Rinott E, Kozer E, Shapira Y, Bar-Haim A, Youngster I. Ibuprofen use and clinical outcomes in COVID-19 patients [published online June, 11 2020]. Clin Microbiol Infect. doi:10.1016/j.cmi.2020.06.003

childern usually do not transmit coronavirus19 infection,Dr.D.k.Jha,M.D.,Pediatric Pulmonologist,Delhi,India

DR DEV KUMAR JHA - 16 Jul, 2020 - INFECTIOUS DISEASES,Respiratory, - 0 Comment

Coronavirus 19 is a potential lethal virus causing Coronavirus disease 2019.

This disease has made realisation of its presence all over the world .

All age groups are being infected with this disease with varying morbidities and mortalities.

The disease has disrupted the educational and economic activities,all over the world.Schools are closed for a long time all over the world in the fear of spread of the disease among children and then in the household.

Researchers have studied 4130 cases through hospital surveillance network between 10,March 2020 to 10,April 2020.Among them 40 cases were children below 16 years of age.Household and parents were called for contact tracing .

It was observed that,in 79% of cases, the source were an adult in the household who were either diseased or infected prior to the infection in children.

In only 8% cases,children were primarily infected who then infected adults.

It was then concluded that,children, not only suffer from mild form of the disease in majority of cases,but they are also not the source of infection to othe children or adults in most of the cases.

The study was published in PEDIATRICS,the official journal of American Academy of Pediatrics.

In conclusion,there will be very little benefit from closing the schools, but it can adversely affects the academy of growing children.

REFERENCES:Pediatrics. 2020;146:e20201576, e2020004879

Certain hand sanitizers are life threatening,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 - 10 Jul, 2020 - Child Health Guides,Medical Guide,Parents’ Guide,Professionals Guide, - 0 Comment

In the Pandemic of Coronavirus disease 2019(COVID 19) , hand sanitizers are life saving.

It kills most of the micro-organisms which come in contact with hands.

It should be used when hand washing facility with soap and water is either not available or not feasible.

Hand sanitizers should be composed of ethanol and it should be at least 60% ethanol ,not methanol.

It should be rubbed over hands on all sides till the hands become dry.

Methanol containing hand sanitizers can become dangerous when absorbed through skin or ingested.If there is frequent use of hand sanitizers it can be absorbed through skin.Sometimes it can be ingested by children or inadvertently by adults.Some companies are making and selling methanol containing hand sanitizers.

There has been some reports of death,blindness and hospitalisation after ingestion of methanol containing hand sanitizers by adults and children. Methanol are used to create fuel and antifreeze.

SIGN AND SYMPTOMS OF METHANOL TOXICITY: Nausea,vomiting,headache,blurred vision.

There may be permanent blindness,seizure,coma,permanent neurological damage and death.

FDA has warned against the use of methanol containing hand sanitizers ,stating that some companies are taking undue advantages of coronavirus pandemic and selling methanol containing hand sanitizers.

It is being recalled from the market .It should be disposed properly using hazardous waste container and should not be poured into drain and should not be mixed with any fluid.

REFERENES;fda.gov

Newborns born to COVID 19 positive mother are not at risk,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 - 03 Jul, 2020 - Professionals Guide, - 0 Comment

There is a common belief that infants born to COVID 19 positive mother may have COVID 19,and their immunological status is impaired.

71 Newborns were taken in study to know the facts about the disease status and immunological status.

After exclusion criteria,51 Newborns were included in the study.

All mothers were tested positive for COVID 19 during third trimester of pregnancy.

Chest X-ray of all mothers done before delivery were consistent with viral Pneuimonia.

Apgar scores at 1 minutes and 5 minutes were assessed for all infants.

All Newborns were separated from the mother and kept in isolation with formula feeds.

Caesarean section was the mode of delivery in most cases.

Non of the Newborns showed any symptom in the form of cough ,fever and breathlessness consistent with COVID19, during the course of hospital stay.

No infant required mechanical ventilation but only few needed low flow oxygen with nasal catheter for <3 days.

Blood samples were taken within 3 days of birth to assess immmunological status.

Pharyngeal swabs were taken after 30 minutes of birth to detect Corona virus by RT-PCR .

RT-PCR were negative in all infants.

The levels of lymphocytes subsets,CD3,CD4,CD8 and CD19 and their proportion were normal except for CD16-CD56 which were below normal.

ImmunoglobulinG and Immunuglobulin M were normal.

Interleukin 6 were elevated and it was very high in one Newborn who developed Necrotising enterocolitis in the third week of life.

There was no correlation between duration of COVID 19 in mother and level of lymphocyte subsets or cytokine in infants.

All Newborns were discharged after 3 consequitive samples were found negative for COVID 19.

The study was published in JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY.

REFERENCES:Liu P, Zheng J, Yang P, et al. The immunologic status of newborns born to SARS-CoV2-infected mothers in Wuhan, China [published online May 10, 2020]. J Allergy Clin Immunol. doi: 10.1016/j.jaci.2020.04.038

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.