2020 - Page 3 of 7 - CHILD AND CHEST HEALTH CARE

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.

CORONAVIRUS DISEASE 2019,(COVID 19),Dr.Dev,Pediatric Pulmonologist,Sahibabad,UP,NCR-Delhi

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 21 Mar, 2020 - Professionals Guide,Uncategorized, - 0 Comment

Corona virus is a novel virus,known as severe acute respiratory syndrome virus-2(SARS CoV-2).It was first identified in the Wuhan city of china in 2019,so the disease is termed as COVID 2019.From China ,it has travelled to every part of world making human as a vehicle.It has killed many people world wide.

In 80% of infected people it causes mild disturbances and may go unnoticed.In about 12 % of cases ,infected persons become severe enough to be admitted in hospital and in about 6% cases ,the infected persons need ICU care.Mortality due to this disease is about 2%.
ROUTE OF ENTRANCE INTO THE BODY: It enters into the body through nose ,when an infected person coughs in the near vicinity of an individual.The virus may survive in air,on the surfaces and fomites for a variable period.It also comes in saliva in contrast to common cold virus.So,it may be inhaled from these sites.
The incubation period is 8-37 days,with an average 14 days.An infected person can shed virus for a minimum of 8 days to a maximum of 37 days.
The virus mainly damages the respiratory epithelium and alveoli of lungs causing pneumonia.
CLINICAL FEATURES;Symptoms are cough,sore throat,difficulty in breathing,headache,bodyache,wekness,confusion,dizziness and in some cases,loose motion and vomiting
LABORATORY FINDINGS;Commonb findings on CBC are,leukopenia,lymphopenia and leukocytosis.Other abnormalities are neutrophilia,thrombocytopenia and anemia.
In severe cases,there may be raised D-dimer and prolonged prthrombin time.
IMAGING;Chest X-Ray shows bilateral lung infiltrates in 75% of cases and unilateral lung infiltrates in 25% of cases.
Confirmation of diagnosis; RT-PCR of lower respiratory tract specimen(sputum,tracheal aspirate,BAL fluid) confirms the diagnosis.Sensitivity of upper respiratory tract specimen(throat swab,nasal swab,nasopharyngeal swab )is low.
HIGH RISK OF MORTALITY:Older age,high SOFA score(sequential organ function assessment) and serum level of D-Dimer > 1mcg/ml are the contion with very high mortality.
TREATMENT;There is no definite treatment as of now.Some antivirals have been tried like oseltamavir,ritonavir and lopinavir with variable results.Hydroxychloroquine has also been tried.
PREVENTION;Prevention is the only cure.Maintain respiratory etiquette,avoid crowded places,and maintain a distance of at least 1 meter(3 feets)

REFERENCES: 1.BMJ Best practice COVID 19
2.Lancet.doi:10.1016/SO140-6736(20)30566-3

WORLD ASTHMA DAY 07.05.2019 ,Dr.Dev , MD, Pediatric Pulmonologist, Delhi NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 20 Mar, 2020 - Child Health Guides,Parents’ Guide, - 0 Comment

World asthma day is observed worldwide on first Tuesday of May.The purpose of this observation is to spread the awareness of Asthma among public.Asthma is the most common chronic respiratory disease of children.

Asthma can occur in first year of life to any age.Any child suffering from repeated episode of cough, breathlessness, chest tightness or wheezing should be investigated for asthma.High level of air pollution is very important trigger factor for flare up of asthma.

Asthma is controllable but not curable my regular use of medications.The cornerstone of Asthma management is inahalational steroid by metered dose inhaler.It should always be taken through spacer and in children below 5 years of age with spacer and mask.

The purpose of this ob

Common cold in mother and Breast feeding.Dr.Dev,Pediatric Pulmonologist,Delhi NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 20 Mar, 2020 - Child Health Guides,Parents’ Guide, - 0 Comment

Common cold is the commonest respiratory disease in children and adults.It is characterised by running nose,sneezing,coughing,fever,headache and generalised bodyache with feeling of low.It is a common belief among mothers that while I am suffering from common cold and breast feed my child,this disease will go into my child through my milk.

This belief is totally wrong.Whenever mother or any member of family is suffering from common cold,child may get infected through close contact because this disease is viral disease and spreads from person to person through air, not through milk or not through saliva.

So it makes no difference,whether a mother feeds her baby or not.If she has common cold,she may transmit it to the baby by just sneezing or coughing near the baby.

So, breast feeding should be continued while mother has common cold.

INHALER MEDICATION/ADDICTION,A MYTH,DR.DEV,PEDIATRIC PULMONOLOGIST,DELHI NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 20 Mar, 2020 - Child Health Guides,Parents’ Guide, - 0 Comment

Inhaler medications in the form of metered dose inhaler(pMDI) with spacer+/-mask is the cornerstone of asthma management in children as well as in adult.There is a common myth in society that once a child starts to take medicines through pMDI with spacer+- mask,he or she becomes addicted to these medicines and device.This belief is completely wrong.These medicines or devices does not contain any substance which makes the user addicted to it.It depends on the severity of the disease that the medications will be needed for how long.

Suppose, a child has been prescribed a lens with spectacle for problem in eyes.Some children will not require it after few months or few years as the child grows.But few children may require it for life.It does not mean that the spectacle or lens has made the child addicted.Same is the situation with MDI with spacer.

So ,whenever your doctor prescribes it ,use it for a period decided by your doctor.