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WORLD ASTHMA DAY 2024,Dr Dev Kumar Jha,MD,Child and child Chest specialist Delhi NCR
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Tonsil removal for improvement in behaviour of children,Dr Deo Kumar Jha,MD.Pediatrician and Pulmonologist,Delhi-NCR
Sleep disordered breathing(SDB) is a common problem in children.
It has been ignored for years till there has been a facility to diagnose it.
Now,there is a facility for early detection of this common problem by a test called polysomnography.
Enlargement of tonsils and adenoid are the main cause of this disorder in children
The main cause of enlargement of tonsil and adenoids for a prolonged period of time is ALLERGY.
Parents are usually not aware of this problem in their children.
The common symptom is snoring in child with frequent disturbances of sleep.
It is graded by hypoapnea/apnea index(HPI) on polysomnography.
The child gradually develops behavioral changes,attention deficit,cognitive problems,day time sleepiness and later on hypertension.
There are two modes of treatment ,one is watchful observation and second is removal of tonsil.
Study was done on 458 children of the mean age of 6 years.
At the end of 12 months of follow up 394(86%),children were available.
It was observed that there was no significant difference between the two groups for the cognitive function.
There was a significant improvement in day time sleepiness and behavioral problems in the group who underwent adenotonsillectomy(surgical removal of adenoid and tonsil) ,moreover,the quality of life were better in the group who opted for the surgical removal of adenoid and tonsil.
CONCLUSION: In case of mild sleep disorderd breathing ,adenotonsillectomy is not advisable for improvement in attention deficit or cognitive problem.
REFERENCES:
Tonsil, adenoid removal improved sleep quality, some behavioral problems in children with mild sleep apnea. https://www.newswise.com/articles/tonsil-adenoid-removal-improved-sleep-quality-some-behavioral-problems-in-children-with-mild-sleep-apnea. Published Dec. 5, 2023. Accessed Dec. 5, 2023.
Is my child suffering from Asthma,Dr Deo Kumar Jha,MD. Pediatrician and Pulmonologist,Ghaziabad,Noida,Delhi-NCR
Know the fact, directly from expert-Dr.Dev,Child and child chest specialist
Is your child facing repeated episodes of cough-Yes/No
Is the cough more problematic during night-Yes/No
Is the cough more problematic while child is playing-Yes/No
Is the cough more problematic when the child eats or drinks cold items-Yes/No
Is the child facing shortness of breath/difficulty in breathing repeatedly-Yes/No
Is your doctor,preferring to nebulise the child more frequently-Yes/No
Is your child facing more cough and or shortness of breath while season is changing-Yes/No
Is your child having itchy skin rashes any time,in addition to cough and shortness of breath-Yes/No
Is your child having itchy nose,frequent running nose,stuffy nose,nose block more frequently in addition to cough and shortness of breath-Yes/No
Is your child takes more time for the recovery of cough and cold than other children-Yes/No
Is your child having cough and shortness of breath when there is no running nose or sneezing-Yes/No
Is any family member whether he or she lives with the child or does not live with the child ,facing symptoms of any kind of allergy-Yes/No
If the answer of most of the questions are YES, there is maximum probability that, your child is suffering from ASTHMA
Asthma is not a disease to be scared of but should be accepted and then appropriate treatment should be given to the needy child.
Asthma is one of the most common chronic disease of respiratory tract in children.
It affects 10%-30% children worldwide.
It is the most common cause of frequent school absenteeism for children.
It affects mental and physical health of children.
It gives financial burden to the family
After appropriate treatment there is negligible school absenteeism,no challenge to the physical and mental health of child and financial burden to the family is significantly reduced.
Dr Deo Kumar Jha,
MBBS(Gold Medalist)
MD(Pediatrics)
Fellowship in Pediatric Pulmonology,AIIMS,New Delhi
Winter depression in children,Dr Deo Kumar Jha,MD. Pediatrician and Pulmonologist,Ghaziabad,Delhi-NCR
Depression is a state of mind in which the mood of a person is very low and the person is not interested in surrounding and any activities which gives him or her pleasure, to the extent that disturbs his or her normal works.
This is known as affective disorder in Psychiatry or mood disorder.
When it occurs for a particular season in year ,it is referred as to seasonal affective disorder-SAD
This disorder is in increasing trends in last 1-2 decades due to various reasons,in children.
The extreme form of this disorder urges a person to commit suicide.
It should be recognised early and addressed properly to keep the potency of a person at normal level.
It has been observed that ,children are particularly at risk to develop this disorder due to stressful family environment.
Vitamin D deficiency is a contributory factor to develop this disease entity ,
In the last few decades ,in India,children have been observed to be busy in indoor activities and more in screen activities.
On the one hand,this indoor confinement leads to less sun exposure and on the other hand the contents of screen may be depressive
In winter season ,naturally there is less time when there is sunlight, in which children can be exposed while playing.
Adequate vitamin D synthesis in the body occurs when skin is exposed to sunlight.
It has been observed that in winter season ,the level of serotonin is less in the body and melatonin balance is also disturbed.
These lead to increased symptoms of depression.
Sun exposure between 10 am to 3 pm is most effective for vitamin D synthesis from ultraviolet B light
Dr Deo Kumar Jha,
MBBS(Gold Medalist)
MD(Pediatrics)
Fellowship in Pediatric Pulmonology,AIIMS New Delhi
Pediatrician and Pulmonologist,Ghaziabad Delhi-NCR
Facts of inhaler medications-Dr Deo Kumar Jha,MD. Pediatrician and Pulmonologist,Delhi-NCR
Advantages of inhaler medications
ROUTES– This medicine goes through the direct routes ,to a site where its action is required unlike oral medications ,which enters the mouth then goes to stomach,then abosrbed in stomach and enters the blood and the blood takes it to the site where it has to work.So ,any hidrance in the path can lower the amount of drug,whereas in case of inhalational route ,there is little chance of hindrance in delivery of drug.
DOSE– Inhalational medications come in microgram which is invisible to the naked eyes,unlike oral medications, which comes in miligram and in the form of tablets or syrups which anyone can see and the quantitiy is 1000 times more than the inhalational medicines for the same action.
Onset of Action-inhalational medicines starts working within minutes unlike oral medicines which may take an hour to start action
Adverse/Side effects- Since,the quantity of inhalational medicines are very very less and it goes directly to the target site,its adverse effects are almost nil even on long time use
MYTHS- There is a false belief that inhalational medicines cause addiction and patient will always require it and can not remain without it. It is baseless belief as the medicines in inhalational routes are the same as in oral medicines and it is not going to make a patient addicted to it. The need and duration of therapy depends on the severity of the disease
THE DEVICE
1.If spacer with valve is used with or without mask,the drug delivery into the target site is approximately 20% and depostion over the throat is about 10-20%
2. If only MDI is used without spacer the drug delivery is only approximately 10% to the target site and almost 50% gets deposited over the throat
3. In cases of use with nebulizer the drug delivery to the target organ is between 1-5% and 50-60% get deposited over the throat
4. In cases of rotahaler, only 1-5% drugs goes to the target site and almost 60% get deposited over the throat
CONCLUSION– 1.Inhalational medications are better than oral medications for long term use
2. Only MDI should not be used directly.It should always be combined with appropriate spacer/ holding chamber
Monkeypox-another threat after COVID-19 ,Dr.Dev(Dr.D.K.Jha) M.D.,Pediatrician and Pediatric Pulmonologist,Rajendra Nagar,Ghaziabad,Delhi NCR
As the name suggests,this disease comes in human from animal,so it is called a zoonotic disease
It is caused by monkeypox virus from the family of poxviridae
It resembles closely with small pox
It comes from animal to human from direct contact with blood,body fluids or muco-cutaneous lesions of infected animals
The natural reservoir is not clear till now but most likely it is rodents-Rope squirrel,tree squirrel
Possible risk factor for getting infected is eating inadequately cooked meat or other products of infected animals
Human to human transmission occurs via close contact with respiratory secretions,objects used by infected persons or mucocutaneous lesions
Prolonged face to face contact may result in transmission of virus through respiratory droplets.
The incubation period is 6-13 days with a range of 5-21 days
Clinical picture can be divided into 2 phases- Invasion phase and eruption phase
INVASION PHASE -It lasts between 0-5 days and characterised by high fever,intense headache,body pain ,back pain ,profound weakness and lymphadenopathy.
Lymphadenopathy differentiates it from other similar viral diseases with rash like measles and chicken pox
ERUPTION PHASE-Skin eruption starts from 1-3 days of start of fever.
Rashes are seen more concentrated over the face and extremities ,less over the trunk.
Rashes may affect palms,soles,oral mucosa and most dangerously the cornea which may be lead to corneal opacity
Rashes evolves from macules to papules to vesicles to pustules, sequentially
These rashes may be few to thousands,crusts and fall off
Rashes may coalesce and a large portion of skin may slough off
It is a self limiting disease and gets spontaneously cured after 2-4 weeks
It may be complicated by secondary bacterial infections,bronchopneumonia,sepsis,encephalitis,corneal involvement and loss of vision
The case fatality(mortality) has been reported to be very high recently and it is 3%-6%
Diagnosis is done by polymerase chain reaction of lesions.
TREATMENT is only symptomatic and only antiviral recommended is TECOVIRIMAT
PREVENTION-Small pox vaccination is very effective but not available now
Recently two doses vaccines for Monkeypox has been recommended but not widely available so personal protection is the cornerstone for prevention
REFERENCES:WORLD HEALTH ORGANISATION(WHO),MONKEYPOX,19 May 22
virus-The most common trigger for asthma exacerbation in children,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Rajendra Nagar,Ghaziabad,Delhi NCR
Asthma is the most common chronic disease in children.
The exact cause of asthma is not clear but there are several theories to explain the cause of asthma.
It is the interaction of genetic predisposition and environment which causes asthma to manifest in children.
Although not a single theory can explain the causation of asthma ,it is clear that, it is a heterogenous disease and there are so many triggers of its exacerbation.
Among triggers, there are ,allergens,pollutants,exertion,cold air,pollens,molds,and sudden change in ambient temperature
Among viruses ,Respiratory Synsytial virus(RSV),rhinovirus,influenza virus and seasonal coronavirus are known triggers for asthma exacerbation in children.
Investigators hypothesized that VIRUSES are the most important triggers for pediatric asthma exacerbation. To prove this ,the investigator studied on children admitted with severe asthma exacerbation in various hospitals form 2014 through 2021. Asthma exacerbation was confirmed through electronic records by continuous use of inhalational salbutamol. Viral testing were done on all children to confirm viral infection.
Investigators studied asthma exacerbation 15 -52 weeks after CDC implemented non pharmaceutical measures to prevent spread of Corona virus disease 2019 ,which limits the spread of virus from person to person including corona virus.These measures are physical distancing,use of mask and respiratory ettiquets.
The average rate of weekly asthma exacerbation in children decreased from approximately 64 % during the period of 2014 to 2019 to approximately 13% in 2020.
The average rate of viral infection positivity decreased from approximately 56% during the period of 2014 to 2019 to approximately 30% in 2020.
Researchers also observed that there was no change significantly in the environmental level of molds,pollens,pollutants and AQI(air quality index)
Researches found that, among various triggers for asthma exacerbation in children ,viral infections were most closely related which was obvious by the measures adopted to spread COVID 19 ,decreased the exacerbation of asthma.
It was concluded that ,measures to minimise viral infections in children will translate into fewer excerbation of asthma in children.
REFERENCES:
Poole A, Holcomb M, Jamieson A, et al. Social distancing reveals determinants of pediatric asthma exacerbations. Presented at: American Academy of Allergy, Asthma & Immunology (AAAAI) 2022 Annual Meeting; February 25–28, 2022; Phoenix, AZ. Abstract 178.
MMR Immunisation protects child from COVID-19,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Rajendra Nagar,Ghaziabad,Delhi NCR
It has been observed that ,children usually suffer from mild to moderate disease due to SARS CoV 2 infection causing COVID 19,in comparision to adults
Mortality due to COVID 19 in children is less in comparision to adults
Children suffering from COVID 19 require less hospitalisation in comparision to adults
The reason for less severity of this disease in children is not clear
In an observational study done in Delhi,India,researchers included 210 children who were immunised for common childhood diseases and were suffering from SARS CoV2 infection as confirmed by Rapid antigen test and RT-PCR test ,considering the incidence of COVID 19 as 2% in children.Data were collected from Distric Immunisation Officer central district New Delhi regarding immunisation and from CDMO Central district New Delhi regarding various stages of severity of disease in children.Children who received 3 doses of Pentavac containing DPT,HiB,HepB,1 dose of BCG,3 doses of Rotavirus ,3 doses of oral polio,2 doses of fractional injectable polio and 1 dose of MR till the age of 1 year were considered compltely immunised.
It has been observed that ,children who received MR/MMR before 1 year of age had less severity of COVID-19 in comparision to children who did not receive MR/MMR.The similar result was not found in mice study.The reason for less severity of COVID 19 in children immunised for MMR is the component of vaccine virus cross react with SARS CoV2 virus.So antibody against Measles and or Rubella produced after immunisation is also protective against COVID-19.BCG vaccinated children also showed less severity of COVID19 in comparision to non BCG Vaccinated children
Other explanation of less severity of COVID 19 in children is that the children have low immunity so do not react strongly to SARS CoV2 virus
It has been concluded that MMR Vaccination provide neutralising antibody against COVID19 causing SARS CoV2
REFERENCES;
1. Salman S, Salem ML. Routine childhood immunization may
protect against COVID-19. Med Hypoth. 2020;140:
109689.
2. Sidiq KR, Sabir DK, Ali SM, et al. Does early childhood
vaccination protect against COVID-19? Front Mol Biosci.
2020;7:1-6.
3. Gomber S, Arora S, Das S, et al. Immune response to second
dose of MMR vaccine in Indian children. Indian J Med Res.
2011;134:302-6.
Indian Pediatrics,Feb 2022
Influenza Vaccine even mismatched to Flu virus can protect children,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Mohan Nagar Ghaziabad,NCR
Influenza vaccine is given to children for protection against Flu
It is given every year according to the guideline by WHO
Every year WHO declears the matched virus vaccine separately for Northern and Southern Hemisphere
In 2019-2020 children suffered from influenza mismatched to vaccine virus
Researchers studied children admitted with the disease from 17 hospitals
All children less than 18 years, underwent RT-PCR test on their respiratory specimen for the diagnosis of Influenza/Flu.
Positive test results were case cohort ,(159 children with median age 6 years),while negative test results were control cohort,(132 children with median age 4 years).
Critical cases were defined by deaths,need of vasopressors,hemodynamic instability, and need of mechanical ventilation
In case cohort ,51% were found to be A/H1N1pdm09 and 25% B Victoria virus.Among A/H1NI pdm09 sequenced 56 children ,52% were vaccine mismatched and 41% were vaccine matched.Among B- lineage, most were vaccine mismatched
It has been found on analysis that the vaccine was effective in 63% cases for any virus,64% against A/H1N1pdm09 and 68% against B- lineage
Vaccine was effective in 75% life threatening cases and 57% non life threatening cases.
vaccine is effective in 78% matched A/HIN1pdmo9 virus and 47 % mismatched virus.It was found to be effective in 78% against mismatched B-lineage virus
It has been concluded that the vaccination reduced the life threatening influenza by 75%
Vaccine efffectiveness were assessed by odds of vaccination in case cohort v/s control cohort
THE MOST IMPOTANT MESSAGE IS ,ALL CHILDREN SHOULD BE INOCULATED WITH INFLUENZA VACCINE YEARLY ACCORDING TO THE AVAILABILITY OF THE VACCINE
REFERENCES:
Olson SM, Newhams MM, Halasa NB, et al. Vaccine effectiveness against life-threatening influenza illness in US children. Clin Infect Dis. Published online January 13, 2022. doi:10.1093/cid/ciab931