Professionals Guide Archives - Page 6 of 7 - CHILD AND CHEST HEALTH CARE

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.

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

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

CAVITORY LESION CAN BE SEEN IN SCHOOL AGE CHILDREN WITH PULMONARY TUBERCULOSIS,DR.DEV,M.D.,Pediatric Pulmonologist,Sahibabad,UP,Delhi NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 20 Mar, 2020 - Medical Guide,Professionals Guide, - 0 Comment

Five year old female child came to me with the history of fever,loss of appetite for 15 days and weight loss for 1 month.On examination,the weight of child is 10 kg which should be 18 kg.On chest auscultation,breath sound was markedly diminished on right inframammary region.Chest X-Ray was done which shows cavity on right mid zone.Contact history for tuberculosis was negative.Clinical setting and chest X-Ray is suggestive of pulmonary tuberculosis.Further investgations are being done to confirm the diagnosis.

Message: Cavitory lesion which is usually seen in adolescent and adults suffering from tuberculosis,may be seen in children with school age group.

NIPAH VIRUS DISEASE IN CHILDREN,DR.Dev,M.D.,Child specialist and child chest specialist,Sahibabad,UP,Delhi NCR

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 20 Mar, 2020 - Professionals Guide, - 0 Comment

Human Nipah virus disease is a life threatening disease with mortality rate of 40-75%.It is a zoonotic disease caused by a paramyxovirus,NIPAH VIRUS,named after a village in Malaysia Sungai Nipah.

The natural reservoir of this virus is large fruit bats of genus Pteropus.Transmission of this virus to human occurs when there is a contact with infected bats,or consuming fruits contaminated with secretions of bats,or infected pigs.Human to Human transmission has ben proved in 2001.

Symptoms of the disease are fever,nausea,vomiting,headache.When the disease progresses,it may cause shortness of breath,and on deterioration ,it may cause,drowsiness,confusion and coma.There may be features of encephalitis.

It is diagnosed by detecting viral antigen by real time PCR,in samples from nasal swab,throat swab,CSF,urine and blood.In the later peroid,antibody may be detected by ELISA.

TREATMENT is mainly symptomatic with supportive care.There is no specific treatment.RIBAVARIN, an antiviral may have role in encephalitis caused by Nipah virus

Rashes over body;Dr.Dev,M.D.,Child specialist and Child chest specialist,Sahibabad,UP,Delhi NCR

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

Rashes over body of children may of different types and due to different reasons.Most common rashes over the body of children are due to allergy.Allergy may be due to any thing which is in the air or which the child commonly eats or drinks.Allergic rashes may cover the whole body within minutes or progresses over the day.Some children may have some congenital defect and they are more vulnerable to allergic rashes.Allergic rashes are usually red coloured and wheel shaped but it can be like pin heads and confluent erythmatous rashes.Sometimes there may be swelling of lips ,tongue and digits.In the most severe form,there is swelling of the larynx(the door to the lungs) causing laryngeal edema and there is spasm (narrowing) of bronchi(airway).In this case life of the child may be endangered.So,any rash over the body of child should not be ignored and a doctor should be consulted as soon as possible.Allergy may be caused by any drug,whether the child has taken it previously or not.Allergy may be due to any vaccine.

Rashes may be due to viral infections in the form of Measles,Rubella,or Chicken Pox.These can be identified only by a qualified doctor.Vaciines are available to prevent these viral diseases..

Rashes over body may be due to some autoimmune diseases which is chronic condition requiring detailed investigations and complex treatment.

Rashes may be due to atopic dermatitis which requires long term treatment..

Rashes may be due to scabies in which case other family members are also affected.

REPEATED COUGH AND/OR DIFFICULTY IN BREATHING MAY BE ASTHMA IN CHILDREN,DR.DEV,M.D.,PEDIATRICIAN AND PEDIATRIC PULMONOLOGIST,SAHIBABAD,UP,DELHI NCR

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

Repeated episodes of cough or difficulty in breathing may be a manifestation of Asthma in children.It is a common belief that,Asthma is a disease of adults and it does not occur in children.The fact is that, Asthma can occur at any age and it has been diagnosed and treated successfully in many infants less than one year of age.

Asthma has a genetic predisposition but a child not predisposed genetically may also develop Asthma.There should be an interaction with offending environment for a child genetically predisposed to develop Asthma.

Asthma in children is an allergic disease of respiratory system.But it may be nonallergic also.Allergy may be due to many things in the air or in the foods.

When a child develop breathlessness,usually parents call it as pneumonia.But it may not be pneumonia,it may be Asthma only or Asthma associated with Pneumonia.There are many conditions in children which looks like Asthma. So an expert and qualified doctor only can diagnose the condition as Asthma.

The mainstay of long term management of Asthma is inhalational steroid.Many parents are scared of steroid.There is no reason to be scared of steroid if it is given in right dose and duration which will be decided by a doctor. Steroid is not a poison,rather it may be nector when it becomes life saving in acute severe exacerbation of Asthma. In such conditions, it is given orally(through mouth) or intravenously(i.v.injections) as the condition permits.

Asthma is not curable but controllable.It must be controlled by regular use of inhalational steroid in children, as the lungs of children are growing lungs, and if left uncontrolled, the lung growth will be hampered .If lungs will not grow properly,body will also not grow properly.

BREAST FEEDING DURING PREGNANCY,DR.DEV,M.D,CHILD SPECIALIST AND CHILD CHEST SPECIALIST,SAHIBABAD,UP,DELHI NCR

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

Breast feeding is the most essential part of infant caring.Every child should be breast fed exclusively for the first 6 months of life.There is no substitute for this.

There are many nutrients available in mothers milk which are not available in other milk.It is essential for the proper growth of infants.It also helps mother in many ways.It is also essential for emotional bonding between mother and child.

There are pressures on mother from family,society and from some medical professionals ,not to breast feed the baby if she has become pregnant again.

There are many explanantions in favour of it.It is believed that, if a mother feeds the baby when she is pregnant again,there will be spontaneuos abortion,there will be preterm delivery,there will be growth retardation of fetus carried by mother,mother will become weak due to nutritional deficiency.

All explanations for not breasting feeding during pregnancy are baseless as per current knowledge.There has been no scientific study to prove these concepts.

The fact is ,mother can continue breast feed her infant while she is pregnant and she has to take nutritious diets and keep her health in good condition.

chest X-Ray is not needed to diagnose Pneumonia,Dr.Dev,Pediatrician and Paediatric Pulmonologist,Sahibabad,UP,NCR,DELHI

Pediatrician and Pediatric Pulmonologist Dr.Dev Kumar Jha,Formerly at AIIMS,New Delhi - 20 Mar, 2020 - Professionals Guide, - 0 Comment

Pneumonia is the most common killer for children below 5 years of age.It is a condition,characterised by fever,Tachypnea,with or without,chest retraction,flaring of ala nasi,head bobbing,suprasternal retraction,cyanosis, and vomiting.If there is only fever and tachypnea,it is called mild pneumonia.If it is associated with chest retration,it is called moderate to severe Pneumonia and if there is cyanosis with refusal to feed with or without seizure ,it is called very severe Pneumonia.

Pneumonia should be diagnosed clinically.Usually chest X-Ray is not required to diagnose Pneumonia.Chest X-Ray exposes the child to ionising radiation which is harmful for a growing lung.But,if the child does not respond to appropriate treatment within 48 hours,or the child deteriorates even after continuous treatment appropriately for 48 hours,chest X-Ray should be done to rule out complications of Pneumonia in the form of Parapneumonic effusion or the most severe form of severe Pneumonia,i.e,NECROTISING PNEUMONIA.

Please see image in the gallary.