Professionals Guide Archives - Page 3 of 7 - CHILD AND CHEST HEALTH CARE

Bronchiolitis/Azithromycin/Recurrent Wheeze,Dr.Dev.M.D.,Pediatrician and Pediatric Pulmonologist,Rajendra Nagar,Ghaziabad,Delhi NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 26 Feb, 2022 - Medical Guide,Professionals Guide, - 0 Comment

Acute bronchiolitis is very common condition in infants
It is viral disease ,most commonly caused by Respiratory Syncytial virs(RSV)
In most of the cases, it is mild and does not require hospitalisation
Only symptomatic treatment is needed in most of the cases
It has been observed that most of the physicians prescribe antibiotics for this condition which does work and not needed
Azithromycin is very frequently prescribed in this condition and it is believed that it will prevent future episodes of wheezing in infants and children
Azithromycin is known to reduce the airway inflammation.
To know that,the oral use of Azithromycin in severe RSV infection reduces recurrent wheeze in infants,Researchers studied on 200 children between the age of 1 months to 18 months hospitalised with severe RSV infection with no comorbid conditions.It was a single centre double blind placebo controlled trial.Recurrent wheeze was defined as third episode of wheeze in next 2-4 years and it was the primary outcome of study.Secondary outcomes were annualised use of inhalational salbutamol,annualised episodes of respiratory symptoms,subsequent use of antibiotics and subsequent use of oral corticosteroids
Children were divided into 2 cohorts.One cohort received oral Azithromycin 10 mg/kg for 7 days then 5 mg/kg for next 7 days.Second cohort received placebo.
It was observed that the risk of recurrent wheeze was not different in Azithromycin and placebo groups(Adjusted Hazard Ratio [aHR] 1.45; 95% CI, 0.92-2.29; P =.11). There was no difference in secondary outcomes between two cohorts.
It was seen that the level of interleukin 8 in nasal wash ,which is a marker of neutrophilic inflammation was low in Azithromycin treated group.
It was concluded that the use of Azithromycin does not reduce the risk of recurrent wheeze in children with severe RSV infection although it reduces inflammation.
The study is a part of conference coverage of American Academy of Allergy,Asthma and Immunology, Feb 2022
REFERENCES:
Beigelman A, Srinivasan M, Goss C, et al. Azithromycin to prevent recurrent wheeze following severe RSV bronchiolitis: the APW-RSV II clinical trial. Presented at: American Academy of Allergy, Asthma & Immunology (AAAAI) 2022 Annual Meeting; February 25–28, 2022; Phoenix, AZ. Abstract 456.

MMR Immunisation protects child from COVID-19,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Rajendra Nagar,Ghaziabad,Delhi NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 19 Feb, 2022 - Child Health Guides,Common Childhood Disease,Parents’ Guide,Professionals Guide, - 0 Comment

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

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 12 Feb, 2022 - Child Health Guides,Professionals Guide, - 0 Comment

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

Nitric Oxide ,an Air pollutant, can cause Asthma in children,Dr Dev,M.D.,Pediatrician and Pediatric Pulmonologist Mohan Nagar,Delhi NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 03 Feb, 2022 - Professionals Guide, - 0 Comment

Asthma is the most common chronic disease in children

It is caused by airway inflammation

NO2 ,which is emitted by fossil fuel burning(OIL AND GAS Burning) is responsible for causing airway inflammation

NO2 is mostly emitted by vehicles,agriculture machinary and power plants

Its level is rising particularly in South East Asia

Researchers from George Washington University US have studied in more than 13000 cities about the ground concentration of NO2 and incidence of Asthma between 2000 and 2019 and found that nearly 2 million new cases of asthma in children can be attributed to NO2 in 2019.

Nearly 262 million people are suffering from Asthma according to Global Burden of disease study

NO2 can be a causative factor for asthma and may be exacebating factor as well

This study highlights the importance of controlling air pollution

REFERENCES:LANCET PLANETARY HEALTH ,JANUARY ,2022

Air Pollution increases Pneumonia in children,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Rajendra Nagar Ghaziabad

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 19 Nov, 2021 - Parents’ Guide,Professionals Guide, - 1 Comment

In the period of October-November 2021 ,there is high level of air pollution in Delhi and NCR.
Air pollutants contain particulate matters of different sizes.
Pollutants containing sizes PM2.5 and PM10 are very dangerous.
These pollutants of size pm2.5 and pm10 can enter the respiratory tract of children.
PM 2.5 can easily enter the alveoli and damages it.
High pm2.5 was defined as pm2.5 level more than 10.75 mcg/cubic meter.
In one study published online on 29.10.2021 in Experimental biology and Medicine,out 810 children,220 were included in study and they were divided into two groups,one with high risk group for community acquired pneumonia(126 children) and second group with low risk for community acquired pneumonia(94).Pneumonia was defined by radiographic evidence of opacity consistent with pneumonia.
It was observrd that more cases of pneumonia were diagnosed from the area with high pm2.5 as compared to low pm2.5
The mean level of pm2.5 was 10.75mcg per cubic meter during study period which is lower than the high level set by U.S.Environmental protection agency .
According to the reports by SAFAR(System of air quality forecast and resaearch) Delhi,NCR,the highest level of pollutants including pm2.5,pm10,ovc,so2,co,nitric oxide are being seen in Delhi NCR air between midnight and 10 am in the morning as on 19.11.2021.Air quality index is in very poor category in Delhi,NCR as on 19.11.2021
So, air pollution is a risk factor for pneumonia in children

REFERENCES;1.. Mehta S, Shin H, Burnett R, North T, Cohen AJ. Ambient particulate air
pollution and acute lower respiratory infections: a systematic review
and implications for estimating the global burden of disease. Air Qual
Atmos Health 2013;6:69–83

2. Ostro B, Roth L, Malig B, Marty M. The effects of fine particle components on respiratory hospital admissions in children. Environ Health
Perspect 2009;117:475–80

Molnupiravir,approved for COVID treatment,may be a wonder drug,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Mohan Nagar,Ghaziabad,Delhi NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 05 Nov, 2021 - Professionals Guide, - 0 Comment

UK has become the first country in the world to approve MOLNUPIRAVIR for the treatment of Corona Virus Disease
It is an antiviral drug
It has been approved to treat mild to moderate disease with at least one risk factor for severity like obesity,Diabetes Mellitus,Heart disease
It should be given as early as the disease get detected and within five days of onset of symptoms
It is given twice daily for five days
It acts by altering the genome of virus and rendering the virus ineffective ,at the same time causing no harm to host
In animal study,it has been found to be safe
It is administered orally
It may be a wonder drug with capacity to change the game as the management till now is focussed on vaccine prevention of the disease and currently available antiviral drug Remdesivir is not much effective
REFERENCES;AFP NOVEMBER 05,2021

Cough and cold medicines are killing children,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Mohan Nagar,Ghaziabad,Delhi NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 02 Nov, 2021 - Child Health Guides,Common Childhood Disease,Parents’ Guide,Professionals Guide, - 0 Comment

Cough and cold are the most frequent symptoms seen in children
It has become a trend to keep medicines at home for cough and cold
Many Parents are in habit of giving self medications to their children without any knowledge of dose and frequency of admininstration
Moreover,the dose of medicines keeps on changing in children unlike in adults
Parents are giving cough and cold medications for other purposes also like while air travelling to sedate the baby.
Cough and cold medications containing DIPHENHYDRAMINE ,when given in excessive doses,act as stimulants rather than sedatives.
The preparation containing DIPHENHYDRAMINE has killed many children.
There is evidence that these medications do not lessen the severity or duration of cough and cold.
Maximum deaths have occured in children below 2 years of age
In many homes,children easily access these medicines
THESE MEDICINES SHOULD NEVER BE PRESCRIBED IN CHILDREN BELOW 2 YEARS OF AGE
REFERENCES:Pediatrics: “Pediatric Fatalities Associated With Over-the-Counter Cough and Cold Medications,” “Pediatric Poisoning Fatalities: Beyond Cough and Cold Medications.

How to differentiate Dengue fever from MIS-C,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist ,Mohan Nagar,Ghaziabad,Delhi NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 25 Oct, 2021 - Professionals Guide, - 0 Comment

Severe Dengue fever and Multisystem inflammatory syndrome in children(MIS-C) both are the states of cytokine storm

Both these conditions present almost similarly,clinically

In the period of September-October 2021 both disease conditions are being seen frequently in India

Severe Dengue fever is caused by Dengue virus ,transmitted into human through Aedes mosquito bites

MIS-C is a post COVID 19 state

It is very important to differentiate between these two conditions for the treatment purposes as the treatment of these two are entirely different
In cases of severe Dengue fever the mainstay of treatment is aggressive fluid therapy with crystalloid ,colloid and when needed ionotrops and platelet transfusion if severe thrombocytopenia.
In contrast,aggressive fluid therapy may be life threatening in MIS-C,in which there may be left ventricular dysfunction.In this condition, the mainstay of treatment is intravenous steroid with or without IVIG.Other medications required are low molecular heparin and aspirin.

If there is fever with prominent vomiting,myalgia,erthmatous rashes,profound weakness and on investigations there is leucopenia,severe thrombocytopenia,hemoconcentration and raised serum Ferritin,it is indicative of severe Dengue fever. Positive NS1 antigen and or IgM antibody for Dengue virus confirms the diagnosis
If there is conjuntival injections,swelling of hands and feet,altered sensorium and diarrhoea along with fever, and on investigations leucocytosis,fibrogienemia,raised serum D-Dimer,raised serum IL6 ,it is leading towards the diagnosis of MIS-C. Positive RT-PCR or antibody againt COVID 19 confirms the diagnosis.

REFERENCES:1.Indian Pediatrics:volume 58;15 october 2021
2. Ahmed M, Advani S, Moreira , et al. Multisystem
inflammatory syndrome in children: A systematic review. E
Clin Med. 2020;26:100527.
3. Mishra S, Ramanathan R, Agarwalla SK. Clinical profile of
dengue fever in children: A study from southern Odisha,
India. Scientifica (Cairo). 2016;2016:6391594.

Large population of Delhi NCR children have ASTHMA.Dr.Dev,MD,Pediatrician and Pediatric Pulmonologist,Ghaziabad,Delhi NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 16 Sep, 2021 - Child Health Guides,Common Childhood Disease,Medical Guide,Parents’ Guide,Professionals Guide, - 0 Comment

Delhi is among most polluted cities in the world
Air pollution directly affects lung
Lungs of children are most vulnerable as the lungs are growing.
Children breath in more air than adults due to fast respiratory rate as compared to adults
Particulate matters in air particularly PM10 and PM2.5 can enter the airways and PM2.5 can go into alveoli
The level of PM10 and PM2.5 are 15 times higher in Delhi air as compared to set standard by World Health Organisation
The pollutants in air comprise obesogenic compounds responsible for making a child Obese
Obesity is associated with the development of Asthma in children
According to a cross sectional study done in 3 cities in India including the most polluted city Delhi and 2 less polluted cities in South India-Kottayam and Mysore, Published in LUNG INDIA September-October 2021,approximately 30% children in Delhi are suffering from Asthma.
Almost 50% children reported cough and 30% complained of shortness of breath.
Among 4361 children studying in private schools between the ages of 13-14 and 16-17,boys and girls, 3157 successfully completed the ISAAC Questionnaire and performed spirometry.
On the basis of spirometry ,which shows airway obstruction, a diagnostic component of Asthma,almost 30% children were diagnosed as having ASTHMA.
Most of the parents and children are not aware of this disease in children.
They are not easily accepting the diagnosis of ASTHMA in children, but it is a fact and we should do something proactively to control the level of pollution in cities to control the ASTHMA
The study has been published in LUNG INDIA September-October,2021

REFERENCES;. Singh V, Singh S, Biswal A. Exceedances and trends of particulate matter (PM2.5) in five Indian megacities Sci Total Environ. 2021;750:141461
Cited Here | PubMed | CrossRef
2. Central Pollution Control Board, Ministry of Environment, Forest and Climate Change. National Ambient Air Quality Status and Trends. 2019 Available from: https://cpcb.nic.in/upload/NAAQS_2019.pdfLast accessed on 2020 Oct 28
Cited Here
3. The Lancet Planetary Health. . Government indifference over air pollution crisis in Delhi

UPCOMING WAVE OF COVID-19 and Children,Dr.Dev,M.D.,Pediatric Pulmonologist,Ghaziabad,Delhi NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 25 Jun, 2021 - Parents’ Guide,Professionals Guide, - 0 Comment

The coronavirus disease and or infection has affected all age group of individuals all over the world.
The herd immunity ,means immunity of entire population of an area to fight any disease develops naturally when almost 70% population of that area is infected .
The other way to develop immunity against the disease is,vaccination of the entire population.
It has been in discussion in India for last couple of weeks that,the upcoming wave of COVID-19 will affect only children and there will be large number of deaths among children.
It has been observed till now all over the world that children have been affected lees and mortality has been less as compared to adults.
But fear among parents and among doctors is genuine.
There are two reasons for that.
1. Since the adult population has been widely covered by vaccination,they will either have no disease or less severe disease.Children are left unvaccinated till now ,so the infection will cause various degrees of diseases in children.
2.Although the mortality percentage is less in children as compared to adults,a large population of diseased children will put burden on health care system and as the number of diseased children will be more,there will be less medical care and high mortality
REFERENCES:Interview given by Dr. Bhramar Mukharjee,Professor and chair of biostatistics,Michigan school of Public health,published in TOI,Delhi edition,Friday,25.06.2021