Child Health and Pediatric Medicine, Learning Center

childhood asthma in india need for modifying GINA guidelines for INDIA

2011-07-17T00:26:00.001-07:00

http://drpeds.blogspot.com/ http://funnytrivias.blogspot.com/ Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and KEM HOSPITAL MUMBAI INDIA

national treatment guidelines for malaria

2011-02-20T11:27:00.000-08:00

http://drpeds.blogspot.com/ http://funnytrivias.blogspot.com/ Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and KEM HOSPITAL MUMBAI INDIA

ring enhancing granulomas, vanishing CT scan lesions

2010-11-25T04:01:00.000-08:00

http://drpeds.blogspot.com/ http://funnytrivias.blogspot.com/ Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and KEM HOSPITAL MUMBAI INDIA

tumors,oncogenes,syndromes

2010-11-25T03:55:00.000-08:00

http://drpeds.blogspot.com/ http://funnytrivias.blogspot.com/ Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and KEM HOSPITAL MUMBAI INDIA

floppy infant syndrome

2010-11-25T03:48:00.000-08:00

http://drpeds.blogspot.com/ http://funnytrivias.blogspot.com/ Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and KEM HOSPITAL MUMBAI INDIA

failure to thrive approach

2010-10-11T06:42:00.001-07:00

http://drpeds.blogspot.com/ http://funnytrivias.blogspot.com/ Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and KEM HOSPITAL MUMBAI INDIA

FW: {Pediatric Doctors} Few formulas which might help doctors working in NICU

2010-06-03T12:04:00.001-07:00

Dear Colleagues,

Its a common problem in NICU that due to hypoglycemia or hyperglycemia, we have to either discard the TPN or change the IVF mix. Its a huge loss to the hospitals. I made few formulas to change the dextrosity which I want to share with all of you.

1)Potdar's Neonatal formula to decrease the dextrosity of solution

Present volume-- PV ml
Present dextrosity – PD%
Desired dextrosity – DD%
ml of sterile water required— Y ml

Formula :-
(PV x PD) +(Y x 0) = (PV+Y) x DD

Y=PV(DD-PD)/DD ml of sterile water needed

Exp—
Weight of infant 1 kg
Total fluid required @100 ml/kg/day = 100(PV)
Present Volume—100 ml
Present dextrosity --- 20
Desired dextrosity—18
Ml of sterile water required—

= (100 x 20) + 0 = (100+Y) x 18
= 2000 = 1800 + 20 Y
= 20Y = 2000-1800
= 20 Y = 200
Y = 200/20
Y=10 ml of sterile water

OR

Y= PV(DD-PD)/DD

Y= 200/20

= 10 ml of water

This small amount of water may dilute the electrolytes. For this, either you can add electrolyte in same proportion or may increase the fluid rate to give this extra amount in set time if clinically
feasible.

2)Potdar's Neonatal formula to increase the dextrosity

Present volume -- PV ml
Present dextrosity – PD%
Desired dextrosity – DD %
ml of 50% dextrose required— Y ml

Formula :-
(PV x PD) +(Y x 50) = (PV+Y) x DD

Y= PV(DD-PD)/50-DD ml of 50% dextrose required

Exp—
Weight of neonate-- 1 kg
Total fluid required @ 100 ml/kg/day—100 ml (PV)
Present dextrosity --- 18%
Desired dextrosity—20%
Ml of 50 % dextrose required—

= (100 x 18)+ 50 Y = (100+Y) x 20
= 1800 + 50 Y = 2000 + 20 Y
= 50Y- 20Y = 2000-1800
= 30 Y = 200
Y = 200/30
Y=6.7 ml of 50 % dextrose.

OR
Y = PV(DD-PD)/50-DD
Y = 100(20-18)/50-20
Y = 200/30
=6.7 ml of 50 % dextrose

This small amount of dextrose may dilute the electrolytes. For this, either you can add electrolyte in same proportion or may increase the fluid rate to give this extra amount in set time if clinically feasible.

3)Making IVF mix with D10% and D 50% (or any two solutions of different dextrosity)
In many neonatal nursery IVF mix is made by adding sterile water and D 50%. Which is more costlier. We can make IVF mix by D10 and D50%.

Formula--

General formula for any two solutions with different dextrosity=

Total volume required= TV

ml of solution containing higher dextrosity(HD%)= X ml

ml of solution containing lower dextrosity(LD%)= TV- X ml

Desired dextrosity= DD

X ml = TV(DD-LD)/(HD-LD) ml of HD in TV

ml of LD in TV = TV- X ml

exp-

Total volume required is 100 ml

Desired dextrosity is 16% and we have D10 and D50%

HD=50%
LD= 10%

ml of D 50 (X ml) = 100(DD-10)/(50-10)

ml of D 50% ( X ml) =100(16-10)/40 ml

= 600/40 ml
= 15 ml

ml of D10%= 100-15=85 ml

Manage your finance and manage money through MSN Money Special Drag n' drop

Yale Observation Scale

2010-02-28T06:40:00.000-08:00

Yale Observation Scale (Mc Carthy Pediatrics)

Indications

1.Assessment of febrile child ages 3-36 months

2.Predicts serious infection (Occult Bacteremia)

3.Quantifies "Toxic Appearance" in children

Interpretation
1.Score = 10 :                        Incidence serious illness: 2.7%
2. Score = 11-15                    Incidence serious illness: 26%
3. Score >16                          Incidence serious illness: 92.3%

Scoring

Quality of Cry

Strong or No cry: 1

Whimper or Sob: 3

Weak cry, Moan, or high pitched cry: 5

Reaction to parents

Brief Cry or Content: 1

Cries off and on: 3

Persistent cry: 5

State variation

Awakens quickly: 1

Difficult to awaken: 3

No arousal or falls asleep: 5

Color

Pink: 1

Acrocyanosis: 3

Pale, Cyanotic, or Mottled: 5

Hydration

Eyes, skin, and mucus membranes moist: 1

Mouth slightly dry: 3

Mucus Membranes dry, eyes sunken: 5

Social Response

Alert or Smiles: 1

Alert or brief smile: 3

No smile, anxious, or dull: 5

------------------------------------------------------------------------------------

http://drpeds.blogspot.com/

http://funnytrivias.blogspot.com/

Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and
KEM HOSPITAL MUMBAI INDIA

Pharyngitis

2008-11-29T03:32:00.000-08:00

its true that most pediatric pharyngitis (below 2 yr age) are viral in origin, and bacteria including streptococci are commonly grown from pediatric throats even though the child is asymptomatic. So it becomes relatively unnecessary to perform throat cultures.

"Viruses are isolated in approximately 40% of cases and include rhinovirus, adenovirus, parainfluenza virus, coxsackievirus, coronavirus, echovirus, herpes simplex virus, Epstein-Barr virus (mononucleosis), and cytomegalovirus. Primary bacterial pathogens that account for approximately 30% of cases of pharyngitis in children include GABHS (common), group C streptococci (uncommon), group G streptococci (uncommon), Neisseria gonorrhoeae (uncommon), Corynebacterium diphtheriae (rare), and Corynebacterium hemolyticum (extremely rare)."(ref:http://www.emedicine.com/EMERG/topic395.htm)

Where as its easy to suspect a viral aetiology if some of the symptoms and or signs are present; viz: typical prodrome, cold, conjuctivitis, rhinorhea, wheezing etc; its absence doesnt truly mean its bacterial in origin.

Bacterial sorethroat similarly has some of the characteristic findings like white patch/ granular inflammation /microabscess / associated acute lymphnode enlargement / lymph node tenderness, sinus tenderness, scarlet rash / membrane etc. But absence of these findings may help one suspect strongly a nonbacterial infection.True; nothing is certain.

The real reason to treat pharyngitis emperically and urgently; is the risk of its sequalae like glomerulonephritis, rheumatic fever and kawasaki disease.These risks are always there with even asymptomatic streptococcal pharyngitis; but documentation of streptococcal throat culture negative after therapy gives some clinical satisfaction in curtailing at least some of GABHS disease.

I prefer to stick only to conservative therapy in throat infections, mainly because most of throat and related infections in children below 2 years are viral origin and in children above 2 years, bacterial infections usually localise and also give enough time to observe/evaluatethe course of disease.

The therapy that works best is soothing normal saline nebulisation for throat relief, added to paracetamol for relief from fever and malaise for 2-3 days; keeping a close watch on development of any diagnostic signs for viral /bacterial aetiology, and if required, antibiotics; after a CBC / ASLO / culture as per the regional recommendations.

====================================

http://drpeds.blogspot.com

Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and
KEM HOSPITAL MUMBAI INDIA

Mental retardation a video review

2007-07-10T10:35:00.000-07:00

http://drpeds.blogspot.com/
view the video full screen

Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and
KEM HOSPITAL MUMBAI INDIA

if you are looking for a page and it is not seen here, please check archives or site search. thank you.

2007-05-18T23:21:00.001-07:00

if you are looking for a page and it is not seen here, please check archives or site search. thank you.

http://drpeds.blogspot.com

http://funnytrivias.blogspot.com

Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and
KEM HOSPITAL MUMBAI INDIA

CCF and shock in children

2007-05-18T23:09:00.000-07:00

It may sound very surprising but i need to combine these contrast topics to discuss together. As many a times I come across situations where the treating docs even residents and pediatricians alike have made a common mistake of misunderstanding one as another and created problems for the patients and themselves.

How is it possible?
Shock is a situation caused by disparity between fluid volume and capillary bed manifesting as poor pulse and blood pressure.
CCF or congestive cardiac failure is a condition caused due to increased preload following venous overload or cardiac hypo function.

In late stages both these cases can overlap, as shock can cause cardiac dysfunction and cardiac dysfunction due to CCF can lead to shock.

And thus most patients coming in late stages to emergency room are falsly interpreted as shock or CCF especially when the facility for JVP CVP BP measurements is not available or faulty. ( yes its likely- as BP measurement varies with age size of cuff and the person who is taking BP and there are no clear cut levels in any area or age for lowest normal BP. Also CVP may be difficult due to venous access in shock. The CVP reading change with movements , intervention and position of CVP catheter tip which may require an X-ray to confirm.)

In addition the confusion arises due to possibility of presence of congenital heart disease or carditis in children. if the child had a chronic heart disease, its more likely that the decision fo CCF si very often made, as the baseline hepatomegaly and cardiomegaly as a part of chronic heart failure is wrongly interpreted as acute CCF.

Similarly, as in acute carditis or sepsis, raised JVP the only important clinical sign apart from cardiomegaly, is difficult to examine and interpret especially in infants, the failure of heart is interpreted as shock.

As both these conditions present with common findings at some stage
: Tachycardia, poor or weak pulse and low blood pressure and desaturation.
They are easily confused unless an expert decides from various other clinical markers.

why do we need to discriminate the two: CCF and shock?
Because, the treatment differs.
for CCF the main therapy is volume reduction diuresis and judicious blood transfusion and digoxin. And rarely inotropes.

And in shock its fluid pushes and inotropes.

A wrong judgment will take you in wrong direction with vicious events.

Some basic understandings will help not making this mistake:

Hyponutrition, hypovolemia and shock is a more common entity than fluid overload or CCF in any disease situation. Even empirically patient will be in shock than CCF. Except 2.

CCF is more common in association with sever anemia and congenital hearts in infancy mainly below 6 months age. Please confirm the presence of significant hyper dynamic circulation / chest movements /PH with acute cardiomegaly. No cardiomegaly means no CCF. Severe anemia may be a misunderstanding of poor perfusion, please wait till the Hb report before transfusion.

The most important finding that’s easy to discriminate is liver tenderness and JVP when measured accurately. Shock will never have liver tenderness. Liver tenderness without raised JVP or cardiomegaly is more likely to be hepatitis than CCF. Acute liver tenderness is an important sign of fluid overload especially in managing dehydrations and shock.

Presence of creptations is very important sign provided one gets bilateral symmetrical Velcro crackle in basal interscapular area. If you get asymmetric crepts, its patchy pneumonia and if you get crepts all over chest, its ARDS or pulmonary bleed in shock.

Measurement of CVP is by far the most important and standard criterion to discriminate shock and CCF. This may not be possible easily in many developing countries. But an attempt should always be made to get a CVP line in all cases of suspected shock and CCF. CVP more than 10 is surely CCF and CVP less than 5 is surely shock.

The conditions where shock and CCF coexist more often are cardiomypopathy, massive myocardial infarctions, sepsis with carditis and aortic stenosis and other obstructive lesions of heart. In such cases the management is highly judicious giving adequate to fewer fluids with maintenance of BP to lowest normal to perfuse periphery and judicious use of diuretics with calculated fluid and salt intake. Most care should be taken not to combine diuresis with fluid restriction; and avoiding peripheral inotropes that will do only harm by increasing peripheral resistance however small dose it is.

==================================================================

read http://www.nhlbi.nih.gov/health/dci/Diseases/hyp/hyp_whatis.html
read aug 2008 IJP symposium septic shock Indian journal of pediatrics

http://drpeds.blogspot.com/ http://funnytrivias.blogspot.com/ Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and KEM HOSPITAL MUMBAI INDIA

http://drpeds.blogspot.com

http://funnytrivias.blogspot.com

Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and
KEM HOSPITAL MUMBAI INDIA

experience of tetanus cases from mumbai

2007-04-13T20:23:00.000-07:00

tetanus once considered to be a deadly medical disease, has come a long way in 20th century, as an easily preventable and effectivey curable disease. So much so that its incidence has disappeared from developed countries.
Even though least cases are seen these days due to effective maternal and childhood immunisation programs; in many areas of developing countries like India, do have significant number of patients presenting as tetanus to tertiary care centers. And few of them have mortalities too.

The once famous Jog and patel clinical score criteria based on fever, tachycardia, number and areas of spasm / trismus; and autonomic disturbances is less often used by many pediatricians; and those who use modify as per their covenience, as the dosages proposed according to clinical score; can be as high as 60 to 80 mg/kg of oral diazepam which is usually not supported by standard textbooks. And also the clinical scores do change very often with or without treatment, a titration of oral dose accordingly doesnt appear a logical solution; as oral absorption of diazepam is erratic. ref 1 2 3

What is more important in management of tetanus is correct diagnosis. A lot many cases are wrongly diagnosed as tetanus; as many people are not awrae of what is trismus and how to check for it. Trismus or lock jaw is a clinical condition that is considered very diagnostic of tetanus; ( and as investigations are often useless in diagnosing tetanus, trismus serves as the sole gold standard diagnostic criteria for tetanus); it is characterised by forecful spasm of jaw muscles with inability to open mouth even under mild pressure; and it is demosntrated in best way by introducing a tongue depressor in mouth; rather attempting to do so; will fail to open mouth. Its very prudent to divert child's attention so that voluntary spasms dont coexist.

Tetanus can be diagnosed in absense of trismus from spasms, rigidity of neck trunk limbs and abdomen; with normal sensorium in a child witha focus of infection and / or history of nonimmunisation.

A wrong diagnosis of trismus will take the child for wrong line of management and vicious cycles of diazepam therapy; and lrolonged hospital stay with addition of multiple medicines; and avoiding all further tests; because once a doc makes diagnosis fo tetanus; usually others dont question it.

How does one make a wrong diagnosis of trismus?
1. false interpretation of voluntary spasm
2. examination by inexeperienced doctor
3. patient may have a seizure and may be interpreted wrongly
4. it can be associated with contradictory neurological signs
5. altered sensorium almost rules out tetanus, unless its following severe hypoxia; which is very rare.
6.if the patient presents to hospital after receiving diazepam and one has no clue to check for trismus

So please reecheck the trismus again, preferably by a senior too; and look for supprtive signs / spasms or contradicting neurological signs.

Another important thing after diagnosis of tetanus, is curtailing a spasm at the earliest. if we donot curtails spasms, they add on to precipitate sever bronchospasms and death.

a spasm should be preferably curtailed only with parenteral diazepam; preferably IV ( diluted with blood) or Intramuscular preferably in deltoid; or per rectal (when IV access is not possible); and never oral.

dose of parenteral or oral diazepam given in most books in 0.2 to 1 mg/kg / dose; which in cases of tetanus appears to be refractory. midazolam doesnt prove promising; and has no benefit in tetanus cases.
Remember diazepam almost never causes of respiratory depression even in higher doses (unless added with another drug like phenobarbitone). Almost all cases of diazepam poisoning recover satisfactorily in a week. ALso, the common morbidity follwoing diazepams is mostly due to its cumulative sedation and vasodilation causing intracranial bleeds.

In tetanus, one may need doses as high as 1-5 mg/kg bolus or tetanus preferably in divisions every 10 minutes (for those who are scared of large dose). to curtail an acute spasms. A spasm can also be controlled by giving muscle relaxants or by causing paralysis; but that make sthe child ventilator dependant.. ( and many are scared of intubations in tetanus cases and go for tracheostomies adding another morbidity.

I had used upto 10mg/kg/dose boluses without causing any problems for curtailing the spasms. Only svere bronchospasms may require high dose diazepam.

Other ways, are to start a low dose diazepam infusions after a bolus diazepam; the infusion are usually 0.2mg/kg/hr for no more than 2 days. dose can be increased gradually; till spasm, but once spasm is controlled for an hour, please taper the diazepam drip rate hourly to avoids intracranial bleeds. switch over earliest to oral or rectal diazepam therapy.

oral diazepam therapies are started at doses of 40, 60 and 80 mg/kg/day in mild , moderate amd sever tetanus respectively. With time, the doses have come down to 20. 40, 60 respectively.

The absorption is errartic with oral. addition of antacids hampers absorption and vomitting and gastritis are frequent complications but are easily treatable.

In the past various antibiotics have ben used for various reasons, but as the clostridia are anaerobes, metronidazole as a single drug chemotherapy usuallky suffices unless another bacerial contamination or pus is documented.

Other CNS dperessants like phenobarbitone, chlorpromazine and chlorzoxazone have been trie in past with erratic regimens without any evidence based benefits. Baclofen is a safer switch over drug due to safety of relaxing mainly skeletal muscles. its action usually is seen by 3rd day, dose range form 0.2 to 1 mg/kg/dose 3-4 times a day.

Tracheostomies especially emergency ones have been associated with significant morbidities.

usually the spasms get controlled in 3-5 days, diazepam can be started tapering once 3 days spasm and rigidity free are observed, but needs to be titrated judiciously. Sometimes spasms may recur again to increase the dose of diazepam. ALl can settle in 2- 4 weeks.

Not to forget, the most important therapy in tetanus management is Tetanus immunogolbulin in high dose to titrate with tetanospasmin; usually 500IU in newborns, 1500IU in infants and 2000 to 3000 IU in children to adults; alongwith primary tetanus immunisation fo child and family.

http://www.pedsccm.org/RARE/Tetanus.html
Lorazepam may be preferable . Limited experience with propofol ,Dantrolene Baclofen Further clinical studies needed. Prompt recognition and treatment of autonomic dysfunction are important in reducing the mortality in this disease.

Author Dr Kondekar Santosh is a pediatrician at Seth G S medical college at KEM Hospital Mumbai india. All of the above opinions are his personel opinions out of personel experience, for more details write to santoshkondekar@kem.edu .

malabsorption syndromes: a clinical approach in children

2007-04-11T10:49:00.000-07:00

http://drpeds.blogspot.com

http://funnytrivias.blogspot.com

Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and
KEM HOSPITAL MUMBAI INDIA

peditips

2007-04-10T09:22:00.000-07:00

visit pediatric medicine tips pediatric tips clinical tips child health tips archives at
http://peditips.blogspot.com/2007/01/this-page-is-meant-mainly-for-clinical.html

new tips will be posted at this apge.

http://drpeds.blogspot.com

http://funnytrivias.blogspot.com

Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and
KEM HOSPITAL MUMBAI INDIA

early postnatal care after birth

2007-04-06T11:21:00.000-07:00

http://drpeds.blogspot.com

http://funnytrivias.blogspot.com

Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and
KEM HOSPITAL MUMBAI INDIA

Tuberculosis in Children

2007-02-21T09:58:00.000-08:00

Tuberculosis in Children

by Dr Alpana Santosh Kondekar (Lect: Dept of Pediatrics, TNMC)

for MBBS students only for rapid review

http://www.geocities.com/drkondekar/TBLECTURE.doc clickon this link to down load and save in word format.

http://ep.bmj.com/cgi/content/extract/91/1/ep1

above link takes u to anice article about pediatric pulmonary
TB, from Archieves Diseases in children, Education and Practice issue;

although following article is not derived from above article.

Magnitude of Pediatric tuberculosis:

As the children get infection from adults with chronic
pulmonary tuberculosis; the extent of infection or disease in children is
directly related to prevalence of chronic pulmonary tuberculosis in adults.

Annual rate of infection is 2.1%/year for under 5 year age
group.

Nearly 40 million children are likely to be exposed to the
risk and nearly 3-4 million children under 5 years are estimated to be
infected.

Agent: Mycobacterium Tuberculosis (human type)

Predisposing factors:

Low socioeconomic group

Poverty

Poor ventilation,

Overcrowding

Close contact with sputum positive cases

Unhygienic living conditions

Precipitating factors:

Infections like measles, whooping cough

Chronic diarrhea

Severe malnutrition

Compromised immune status

Transmission:

Droplet Infection

Incubation period: 4-8 weeks

Evolution and timetable of untreated of untreated primary TB
infection

Wallgreen’s Calender of TB events (modified)

Time scale since infection	Comments	Events
0-4 weeks	Infection	None
4-8 weeks	Hypersensitivity / Latent TB, most children get MT positive	Febrile illness, E nodosum, Phlyctenular conjunctivitis
2-4 months	Primary focus, nonspecific resistance, greater risk of local and disseminated	Ghons complex with progressive healing in most cases, Pleural effusion
3-12 months	Focus complications	Pleural effusion (75% cases), Cavity, Coin shadow,
3-9 months	Complications of nodes	Rupture, empyema, bronchopneumonia, consolidation, hyperinflation,
9 – 24 months	Diminished risk of dissemination	Meningitis, military, subcortical tuberculoma rupture, in < 5 yr age, in < than 4% cases
1-3 yrs		Bone, joints, kidneys (>3 yrs)
Resistance reduced by early infection, PEM, measles, whooping cough, steroids etc

Differentiation between Adult and Pediatric TB

Adult type	Childhood
Tissue has already acquired allergy and immunity by prior infection	Infection occurs for the first time, tissue has no immunity to TB proteins
Lowering of immune response/ defense locally in the lungs leads to reactivation & mainly locally progressive disease	T cell response plays a significant role causing disseminated disease in globally immunocompromised children
No significant hilar or regional lymphadenopathy	Well marked regional lymphadenopathy
Hematogenous spread is uncommon	Lymphatic and hematogenous spread more common than local spread !
Cavitatory lesion may be seen	Common with MDR & HIV positive patient
Chronic pulm. TB is highly infectious	Iary infection is usually noninfectious
In adults main cause of death and disability is pulm. TB	Main cause of death and disability is non pulmonary TB
Healing of the lesion is mainly by calcification/ fibrosis	Calcification is more common, fibrosis is unusul

Pulmonary Pathogenesis of Pediatric TB

Parenchymal Progression

Ghon’s focus = lymphangitis + enlarged Lymph nodes

Primary complex

Healed Primary complex

Pneumonia

Massive pneumonia

Primary cavity

Bronchopneumonia

Pleurisy

Lymphatic progression:

Mediastinal LN

Partial bronchial obstruction

Complete Bronchial obstruction

Obstructive emphysema

Collapse

Collapse consolidation

Synpneumonic effusion

Rupture of bronchus/ fistula

Subcarinal LN causing tracheal splaying

Hematogenous Progression:

Acute military TB

Protracted or disseminated TB

CNS – tuberculoma, TB Meningitis,
Ritchies focus

Dactylitis

Spinal TB (Potts)

TB psteomyelitis

Chronic Pulmonary TB:

Assman’s focus (subapical)

Pulmonary infiltration – cavity

Bronchogenic spread – bronchiectasis

Extensive bilateral fibrocaseous TB

Fibrous phthisis

Investigations:

Family History and family screening

Hematological = Hb ESR

MT test

XR chest

AFB gastric Lavage

USG abdomen – for LN and ileocaecal
Tb

CTscan Brain – tuberculoma and
exudates

LN biopsy

Sputum , CSF , pleural fluid, urine,
blood, culture

Tr Br Lavage

ELISA/ TB PCR Tests

Mantaux Test:

TU PPD with RT 23 or 1: 1000 is used with preferably a dose
of 5 TU, to detect greater number of true positives,

Given intradermally, read after 48-72 hrs

Palpate and measure induration , not erythema

Positive test reaction = 10 mm or more

Mild / + 0-14
mm

Moderate / ++ 15-20
mm

Severe +++ 21-30
mm

Very severe reaction ++++ blisters/ necrosis
or more than 30 mm

Treatment:

General supportive

Dietary

Environmental and psychological counseling

Chemotherapy with AKT

RNTCP

DOT regimen

IAP

Intensive phase + continuation phase

Indian Academy of Pediatrics ( IAP) consensus for TB
management in children

Cases divide in 5 groups

Group I: 6 HR

Asymptomatic MT positive < 3 yr age

Asymptomatic MT positive <5 yr with PEM III IV

MT positive : recent converter (no sings or healed
lesions)

Child less than 3 yr with family contact history

Child < 5 yr with PEM III IV and contact

Group II: 2 HRZ + 4 HR

Primary complex

Symptomatic MT positive < 3yr, without localization

Symptomatic MT positive < 5 yr + PEM III IV without
localization

Isolated LN disease

Pleural effusion

Group III: 2 HRZE + 4 HR

Progressive
pulmonary disease

Multiple TB LN disease

-------- if
nonresolving, can be extended by 3 months

Group IV: 2HRZE + 7 HR

Miliary or
disseminated disease

Cavity
disease or bronchopneumonia

Osteoarticular
disease

Abdominal
pericardial or GU disease

Group V: 2 HRZE + 10 HR

Neuro TB

Dosage
recommendations: mg/kg/ dose/ day

Drug	Daily therapy	Intermittent therapy
INH	5	15
RMP	10	15
PZA	25	30
EMB	20	30
SM	20	30
Prednisolone	1-2	-

Prednisolone:

Indicated
in:

Neuro TB,
Miliary TB

Serous TB

Endobronchial
Tb/ segmental lesion

GU TB/
sinus formation

Special cases:

Baby born to TB mother: in IIIrd
trimester

Breast
feeding may be continued

BCG to be
given at birth

If XRChest
normal, give 6 HR

If XRchest
abnormal 2HRZ+7HR

Congenital
TB 2 HRZ + 7 HR

BCG adenitis:

If LN is
small. < 1.5 cm = no treatment required

Increasing
or fluctuant = 6 H

Excision
+/-

Drugs for MDR TB:

1. Ethionamide

2. .Fluroquinolones:
double dose

a. Ciprofloxacxin

b. Ofloxacin

c. Sparfloxacin

d. lamefloxacin

3. Aminoglycosides

a. Kanamycin

b. Amikacin

4. Cycloserine

5. rifamycin
derivatives

a. rifabutin

b. rifapentin

c. rifadine

d. CGP.
FCE etc

For any queries, write to drdoctor@hotmail.com

Pediatric Tuberculosis Fact Sheet - American Lung Association site
The lack of pediatric dosage forms of most anti-tuberculosis medications ... The best method to prevent cases of pediatric tuberculosis is to find, ...

Management of Pediatric Tuberculosis Under the Revised National ...
Management of Pediatric Tuberculosis Under the Revised National Tuberculosis Control Programme। Indian J Pediatr [serial online] 2004 [cited 2007 Jan 1] ...

Tuberculosis in Children - Keep Kids Healthy
Chemotherapy for Tuberculosis in Infants and Children : From the American Academy of Pediatrics, treatment guidelines for infants and children with ...www।keepkidshealthy.com/WELCOME/infectionsguide/tuberculosis.html

eMedicine - Tuberculosis : Article by Vandana Batra, MD
AAP: Update on tuberculosis skin testing of children। American Academy of Pediatrics Committee on Infectious Diseases। Pediatrics 1996 Feb; 97(2): ...www.emedicine.com/PED/topic2321.htm

guidelines for the management of tuberculosis in children living ...
File Format: PDF/Adobe Acrobat - View as HTMLSan Diego Pediatric TB Task Force. Subcommittee on guidelines for the management of pediatric tuberculosis. Alice Pong MD - Director*. John S. Bradley MD* ...www.lungsandiego.org/pdfs/lungsd_TB_गुइदेलिनेस४स्द्

Pediatric tuberculosis in Canada - CCDR Vol. 29-16 - Public Health ...
Tuberculosis continues to be a significant cause of morbidity and mortality for children throughout the world। In Canada, TB in children steadily declined

Pediatric tuberculosis: clinical presentation and contact ...
OBJECTIVE: (A) To characterize the clinical presentation of pediatric tuberculosis in Los Angeles County; (B) to determine the efficacy of contact ...

Pediatric Tuberculosis: What Needs to be Done to Decrease ...
Key words: pediatric tuberculosis, tuberculosis control, tuberculosis prevention, computer simulation models. This article has been cited by other articles

Pediatric Tuberculosis: An online presentation
Pediatric Tuberculosis: An Online Presentation. This slide presentation with streaming audio provides information to strengthen the diagnostic and treatment ...

Francis J. Curry National TB Center Pediatric Tuberculosis: An ...
The listener’s guidebook includes tools to assist providers in the management of pediatric tuberculosis

http://drpeds.blogspot.com/

http://funnytrivias.blogspot.com/

Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and
KEM HOSPITAL MUMBAI INDIA

inotropic support , dopamine , and other inotropes in children

2007-01-30T10:46:00.000-08:00

http://drpeds.blogspot.com

http://funnytrivias.blogspot.com

Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and
KEM HOSPITAL MUMBAI INDIA

Department of Pediatrics: KEM Hospital: home page

Dear Pediatricians and resident doctors,

Receptor pharmacology

Agent	Alpha₁	Alpha₂	Beta₁	Beta₂	Dopamine
Dobutamine	+	+	++++	++	0
Dopamine	++/+++	?	++++	++	++++
Epinephrine	++++	++++	++++	+++	0
Norepinephrine	+++	+++	+++	+/++	0

Dopamine drip

[6 ><>

It can also be calculated as:

Amount of dopamine to be added to 100 ml of IV fluid =
6 multiplied by wt and desired dopamine rate in ug/kg/min; divided by IV fluid rate in ml/hr

Precautions:
Before starting dopamine drip; elliminate low volume states by giving two pushes of 20cc/kg of RL/ NS
Presence of good urine output justifies good renal perfusion and rules out need for dopamine.
Pulse may go weak on dopamine due to its vasoconstrictor action if it were started on low volume.
Always start with 5ug/kg/min then go higher as reqd within 30 min.
It should be avoided or used judiciously in cases of pulmonary edema, as it increases PVR.

CALCULATIONS ARE SAME FOR DOBUTAMINE, FOR Ad; USE 0.6 INSTEAD OF 6

Agents	Site of Action	Dose mcg/kg/min	Effects
Dopamine	Dopaminergic Beta alfa>beta	0.5-4 4-10 11-20	Renal vasodilator Inotrope Peripheral vasoconstrictor Increased PVR Dysrhythmias
Dobutamine	Beta1 & Beta2	1-20	Inotrope Vasodilatation Beta2 Decreases PVR weak Alfa activity Tachycardia & Extrasystoles
Isoproterenol	Beta1& Beta2	0.05-2.0	Inotrope Vasodilatation Decreases PVR MVO2 Dysrhythmia
Epinephrine	Beta > Alfa	0.05-2.0	Inotrope Tachycardia Decreased Renal Flow MVO2 Dysrhythmia
Norepinephrine	alfa > Beta	0.05-2.0	Profound constrictor Inotrope MVO2 SVR
sodium Nitroprusside	Vasodilator: Arterial greater than Venous	0.5-10	Rapid onset;short dur.n Incrreases ICP V/Q mismatch Cyanide toxicity
Nitroglycerin	Vasodilator: Venous greater than Arterial	1-20	Decreased PVR Increases ICP
PGE2	Complex	0.05-0.2	Vasodilation Open Ductus Arteriosus
Amrinone	PDE3 Inhibitor	1-20	Inotrope Chronotrope Vasodilatation

A simple calculation for Dopamine drip--

To keep rate upto 5 mcg/kg/min add 9 small tuberculin units of dopamine per kg body weight for 12 hr drip.

if you need double rate,double the amt of dopamine i.e. for 10mcg/kg/min add 18 OTU/kg/12 hr drip

now as far as iv fluids are considered:

can be modified as below:

(after first month of life)

2.5 kg = 10 ml/hr = 10 udps/min

5kg = 20ml/hr = 20udps/min

7kg = 30 ml/hr = 30 udps/min

10kg = 40 ml/hr = 40 udps/min

15 kg = 50ml/hr = 50 udps/min

20 kg = 60 ml/hr = 60 udps/min

in between for each Kg add 2 microdrops extra/minute

Thanks to 1ml/hr = 1 udropper minute,

as one macrodrop = 16 microdrops;

1ml= 60 microdrops # 60seconds = 1 minute

For Dopamine drip=
0.0015 × wt. × Rate × duration = ml of Dopamine (for 1ml of Dopamine = 40mg) to be added to the syringe pump.

Weight = in Kg

Rate = µg/kg/min of Dopamine

Duration = in hours

For Dobutamine drip =
0.0048 × rate × duration × wt. = ml of Dobutamine (for 1ml = 12.5 mg of Dobutamine) to be added to the syringe pump.

Weight = in Kg

Rate = µg/kg/min of Dopamine

Duration = in hours

http://www.aic.cuhk.edu.hk/web8/inotropes.htm

This page is meant mainly for clinical tips.. pediatric medicine tips and tricks

2007-01-30T10:34:00.000-08:00

http://drpeds.blogspot.com

http://funnytrivias.blogspot.com

====================================================
Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and
KEM HOSPITAL MUMBAI INDIA

====================================================
02/05/2007
all our PICU cases are dying of pulmonary hemorrhages after a weeks stay.

tip: u r surely dealing with klebsiella sepsis, reason is poor handwashing and hygiene in ICU. the cause can be heavy dose of sedations occasionally and if with pneumothorax may be high presure settings in children (can be easily avoided by switching to higher frequencies than pressures). In most such cases, radiologist will report X ray as ARDS, and if the adequate antibiotics dont reach in advance before the bleed, surely death is a sequalae.

====================================================

01/05/2007
my patient is on dopamine and dobutamine both max limits still the pulses are not felt , BP is normal.

========= dear, when BP is normal there is no need for inotropes. if pulses are not felt or dusky, please cut o`ff the inotropes as they are harming the patient. if BP were low in addition, i would like u to make sure that there is no extra dose of diuresis or the fluids are restricted, cos in these situations of hypovolemiua, inotropes wont work.

06/07/2003
Most of my patients with fever chills, who I send home on chloroquine; they come back within 24 hrs saying no effext! Is it chloroquine resistance?:

TIP:not resistance but lack of some precaution on your part.; See it takes at least 26 hrs to get control over fever after starting chloroquine. If you had taken time to tell pt that fever may recur in 36 hrs, he wouldnt come to you at the next spike of fever. Also some other imp points which you need to tell him are: Shivering/sweating is nothing to worry (!), blankets may aggrevate temp.; Vomitting may be common following tablets. (Why dont you habituate yourself to give the first dose of chloroquine in hospital itself?. Its prefered that it should be given with food but even glucon D suffices; also countering the hypoglycemia effect)

====================================================
23/06/2003
how will you suspect URTI in a <5 child without opening his mouth:

TIP:pediatricians are best magicians.; a toddler or an infant with URTI doesnt open his mouth often ; infact he keeps it tight; if opened- that just to cry. The vomiting associated with same is just bcos child had not swalloed the contents that were introduced in his mouth in last few hr

====================================================
23/06/2003
a 2 yr boy presents with fever and loose motions vomitting and excessive crying; no dehydration, motions semisolid to loose but not responding to hydration and IV metro; its 3rd day today and baby is still excessively crying, CSF study is normal :

TIP:small precautions always avoid big mistakes; If you had checked babies throat or ear with caution; you wouldnot hv missed the parenteral diarhoea. Excessive crying and vomitting persisted bcos you never treated his URTI.

====================================================

30/05/2003
what is the commonest cause of vomitting in children, that doesnt respond to antiemetics?:

TIP:URTI!!; the way to deal vomitting in such cases is: saline neb/soothing, liquid sweet diet for a day or two and slow feeding for a day or two ! lo!!! no vomitting!!!
====================================================

17/05/2003
what are the four commonest causes of excessive crying?:

TIP:Its natural!! 1. hunger, 2. URTI 3.earache 4.colic;

====================================================

17/04/2003
A breathless child whenever put on O2 hood, becomes restless, hyperactive and throws out everything:

TIP:Its natural!!; in fact its very oddly suffocating... always look for baby's comfort; turn to side, keep him soothed by humidifying O2 and Frequent Nebulisation.or Intermittently give backrest so that he will be oriented in surroundings. Best is to use nasal prongs/or catheter; with it baby can be mobile and think of feeding too. (Also avoids O2 wastage)

====================================================

16/04/2003
Almost every mother tells my baby has always forehead temp, its always there but doesnt come in thermometer. How to approach?:

TIP:Counsel and convince; Children have a rapidly growing brain which has a high BMR which emits heat, and is normal unless body is also warm/hot.

====================================================

14/04/2003
Hyperpyrexia is very common, at times chilren requires high doses of paracetamol, but fever fails to come down even with forehead cold compresses?:

TIP:Cool Down ; Not really, unless sepsis, asphyxia or pontine bleed, other causes like heat stroke are les common. Avoid thick cloths/blankets, take child to open air/fan/AC (despite shivering+/-). keep NORMAL temp compressses over chest and abdomen/back (forehead doesnt help) . Fever has to come down in 20 min with single dose PCM; if doesnt... truly think of other causes

====================================================

07/04/2003
We have a 6 month old baby presented with breathlesness since 24 hrs, not responding to cefitaxim amikacin, xray shows some streaking, RR is 80 what to do?:

TIP:Cool Down ; How could you think its an infection? If fever is there, why do you want to treat a viral bronchiolitis with antibiotics?

====================================================
25/03/2003
Our ventilator patients always need pavlon or midazolam drip, otherwise they fight on ventilator and not maintain saturation:

TIP:avoid breathing against ventilation, 1. Donot keep any child on CMV/IPPV if he has good respiratory drive! => use SIMV/PSV/CPAP as applicable (with minimum rate of 20 which will help even if he fatigues) . 2.At times judicious sedation for SHORT WHILE may be required to allay the anxiety of child! 3. And if a child can pull his tube out , may be he doesnt need it...(just try and see) 4. Did you mistake acidosis as tachypnea?

====================================================

24/03/2003
our Xrays are always over or under exposed, so we could never get exact picture in a case:

TIP:3 simple tricks, 1. try reading the Xray obliquely; by this most pleural effusions seem to be NOT THERE! 2.Read white(overexposed) Xrays against white background(e.g. bedsheet); the white will stand out! 3. Read black xrays against redlight/dimlight; the black will stand out. And the best way is to scan the Xray and see it under changing resolutions in adobe/photoshop, every milimeter of chest will be clearly interpretable.

====================================================

21/03/2003
Its preferable to keep a child with respi distress on ET- O2/T piece if not ventilating by machine:

TIP:NEVER ! Unless the distress in child is bcos of laryngomalacia, the above exercise will in fact worsen distress by narrowing the airway diameter and offering outflow resistance, What is required for such kind of patients is CPAP which can be nasal/pharyngeal (or ET)

====================================================
19/03/2003
patients are difficult to wean from tracheostomy bcos of plenty of secretions:

TIP: WRONG! If the patient has a good gag reflex, and no URT pathology, the patient improves following tracheostomy and in fact patient is able to take the secretions out effectively.

====================================================

18/03/2003
all children with brochiolitis land up with trachiostomy/ ventilator:

TIP: wrong policy and management only lack of patience; willful restraint and insufficient hydration will take you in that direction. physical comfort to child is the best solution.

====================================================

16/03/2003
all children with status epilepticus require a second anticonvulsant:

TIP: very rare. I am sure you must not have loaded the child with enough(20mg/kg) of first anticonvulsant or you must be treating metabolic seizure with anticonvulsants.

====================================================

all children need to be tied to bed, as they frequently remove their RT or put their IV in mouth:

TIP: just give elbow splinting If you dont allow elbow to flex, all this is avoided.

====================================================

breathlessness in a child not improving with Nebulisation,chest is clear:

TIP: do nasal suction nose block is very common.
mother give history of child not taking anything orallyU dont find any reason:TIP: did you see the throat?
whenever a child doesnt open mouth, :TIP:always look for glands and 100% his throat is infected

====================================================

14/03/2003
I always use a proper size laryngoscope, but I cant see larynx/oesophagus easily:

TIP: pass a feeding NG tube, then only other opening is larynx. Hold laryngoscope blade obliquely across the tongue so that it doesnt fall back to hide larynx. And ofcourse cricoid pressure makes it 'done'. AND whenver you are in doubt, remove the tube and give BMV; its phenomenal.

====================================================

The patients i intubated, never survived. or every patient intubated, soon goes on Ad drip:

TIP: Make it a habit to give atropine prior to intubation. . even in dior emergencies, you can always give BMV till its done (most of the time, (it takes only the time taken to open the ET).

====================================================

I could never see enough chest rise while giving BMV:

TIP: Doctor, you either forgot the HEAD TILT CHIN LIFT or the mask is big size.

====================================================

AMBU is useless,as its very difficult to achieve good SPO2 with it:

TIP: Ofcourse yes, and only if you are not using a reservoir.

====================================================

Every patient of TBM and CHD goes on dopamine:

TIP: only if you underestimate/undertreat the dehydration by 'unanition' and restrict the fluid despite diuretics.

my patients on dopamine, always worsen and require higher doses and worsen more:

TIP: they do worsen only if the hydration was not maintained by 2 RL pushes (with maintainance fluids) prior to dopamine. AND also when it was started in presence of severe pulmonary edema.

==================================================
patients with prolonged PT bleed continuously despite, plasma cover:

TIP: please... give a good gastric lavage and enema every day.. and observe for fresh bleeding tendencies. Give a break to Plasma if no bleeding tendencies for 24 Hrs

Scarlet fever

2007-01-22T02:47:00.000-08:00

http://drpeds.blogspot.com

http://funnytrivias.blogspot.com

Scarlet Red
Isnt all well read !

Japanese RED boy = kawasaki disease
Asian RED boy = scarlet fever
African RED boy = Kwashiorkar ?

Scarlet fever
Has been a major morbidity and mortality
In prepenicillin era; in epidemics
The incidence and severity decreased over years with changed streptococcal virulence in response to newer antibiotics.
Rash develops in fewer than 10% of cases of "strep throat."

incidence
Age 4-8 years peak
By the time children are 10-years-old, 80% have developed lifelong protective antibodies against streptococcal pyrogenic exotoxins.
Scarlet fever is rare in children younger than 2 years, because of the presence of maternal antiexotoxin antibodies and lack of prior sensitization.

Despite incomplete Kawasaki label
Scarlet fever is easy to diagnose..
Seen in kids not exposed often to streptococcal infections; thus not having any antibacterial or antitoxin immunity.

Diagnostic is red ..
Red tonsils red tongue and red rash !
White – red- strawberry tongue
Starts on face, nonpunctate; on trunk it is punctate erythematous boiled lobster appearance
And evidence of Hemolytic Streptococci

Other signs: falsly diagnostic
Circumoral Pallor
Pastia sign
Pin hole peeling

Differentials
If rash is illdefined with mild tonsil = Rubella
If rash is confluent = closer to measles
If exudative tonsillitis = closer to staph
Macular rash = drug rash
Tender nodes = adenitis
Nondiscrete LN = closer to diptheria
If no strept = incomplete Kawasaki

Clinical variants
Mild = ambulatory, fever is major symptom
Moderate = toxic look, with some dysphagia
Severe = bedridden
Septic Scarlet fever = local sepsis/ perf
Toxic Scarlet fever = systemic sepsis
Extrafaucial scarlet fever

complications
ENT purulent –it is, pneumonia , meningitis
Adenitis
Vulvovaginitis
R Nephritis
R Myocarditis
R Polyarthritis

Risk following an untreated streptococcal infection

Acute rheumatic fever : 3% in epidemic 0.3% in endemic scenarios
Glomerulonephritis 10-15%

Easy to treat…
Hemolytic strepts respond promptly to benzyl penicillin and Benzathine Penicillin
10 days oral penicillin

Use of any other drug indicates lack of knowledge on part of the prescriber

Why not….
Other penicillins.. Less effective for hemoStrept
Tetracyclines and cephalosporins .. Less potent
Erythromycin .. Resistance coming up
Sulfa drugs = incomplete eradication
All these drugs are good for prophylaxis and less effective for eradication of strept.

Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and
KEM HOSPITAL MUMBAI INDIA

anticoagulation in children

2006-12-23T21:51:00.000-08:00

a review and update of pediatrics and various topics related to child health

click below for the detailed article

http://geocities.com/anticoagulationinchildren

pediatric hypotension. Low blood pressure in children

2006-09-30T12:48:00.000-07:00

Its ironic to believe that there are no standards set / studied or developed to diagnose pediatric hypotension. Low blood pressure in children is defined and taken as different pediatricians and hence are the maximum confusions and unnecessary use of inotropes and development of complications.

In most developing countries, low normal blood pressure is very common, its mainly related to poor nutrition including decreased intake. More so in children when any illness in children predominantly results in decreased intake and thus subclinical hypovolemia.
I had personally attended many deaths in children in intensive care settings in tertiary care settings, they aere associated mainly with hypovolemia whatever the diagnosis be.
Sometimes it was fluid restriction, sometimes inadequate correction of fluid deficit and sometimes excess diuretic administration with fluid restriction.All these surely worsen hemodynamics in
situations like nephrotic syndrome, shock sepsis, meningitis, congestive geart failure etc.

here are simple rules that help us in avoiding unnecessary use of inotropes in children especially dopamine , dobutamine and adrenaline.

following are the levels of systolic blood pressure lower normal limits below which inotrope support may be warranted provided a failur to fluid resucitation is documented with at least 60 ml/kg fluid infusion in 2 hours.
weight of child blood pressure lower normal systolic
1-2 kg 50 mm Hg
3-10 kg 60 mm Hg
10 kg and above 70 mm Hg (plus double the age in years, when age is 10 or more)
( according to standard guidelines the inotropes need to be started below 60 mmHg systolic BP in newborn, below 70mm Hg in infants and below 80 mm Hg in children upto 10 years, and above 10 years below 90 mmHg.

Most books give guidelines to maintain systolic BP to 50th centile, and give guidelines as when it drops below 50th centile, start inotropes. But this is unjustified in clinical settings when there is a significant chance of the blood pressure being normal even at 10-50th centile. So considering the normal Gaussian variation, every blood pressure cant be treated with inotropes when it starts falling below 50th centile.
Lets just give a thought, why is blood pressure needed for? to perfuse the distal most part of extremeties to maintain oxygen distribution and saturation to 96%. If the same is maintained, which can be easily assessed and monitored in children due to tehir thin skin; why is there a cry to maintain systolic BP even if saturation and perfusion is stable and normal.

Blood pressure being regulated by various mechanisms and can change with childs activity, movement of cuff tube and cuff size and also proper size BP cuffs in children is a known rarity often, its impractical to trust the readings of BP just to define hypotension. And since ist last thing to change, may be you have to wait to see the effect of ongoing therapy?
(the arguments made by many are that if BP is at 50th centile or just below it, that means body has given an indication of failing BP regulation and needs inotropes; but friends, thats not so; as if body regulatory mechanisms fail, it should immediately drop below 10th centile.

To summarise, for all practical purposes, fluid resuscitation is warranted as life saving measure, when
newborn systolic blood pressure falls below 50 mm Hg
infant systolic blood pressure falls below 60 mm Hg
and systolic child blood pressure falls below 70 mm Hg

REMEMBER DONOT THINK OF INOTROPES UNLESS YOU HAVE MADE SURE THAT BODY HAS ENOUGH BLOOD VOLUME (40-80cc per kg) IN BLOOD VESSELS, THIS CAN BE CONFIRMED BY CHECKING CVP, IT SHOULD BE MORE THAN 5 TO START INOTROPES (or at least 60-80 cc/kg fluid has to be pushed in), SO BUILD UP VENOUS VOLUME BEFORE GETTING INOTROPE SUPPORT.

Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and
KEM HOSPITAL MUMBAI INDIA

methods of recording BP

2006-05-23T09:02:00.000-07:00

Infants	Older children
Auscultation	Auscultation
Flush method
Palpation method
Ultrasonic (Doppler) and oscillometric (Dinamp) devices

Blood pressure should be measured after 3-5 minutes of rest in the seated position with the cubital fossa at heart level. Infants and toddlers may be supine. The cuff should be inflated to a pressure of 20-30 mmHg above systolic blood pressure with a cuff deflation rate of 2-3 mmHg/sec. It should be recorded at least twice on each occasion.

Systolic blood pressure is determined by the onset of the ‘tapping’ Kortokoff sounds. The definition of the diastolic blood pressure is changed from muffling of the K sounds (the 4^th Kortokoff sound) in children under 13 years old to the disappearance of the sounds (the 5^th Kortokoff sound) in children of all ages.

Dr kondekar santosh venketraman
child health specialist at HIS best!
9869405747
Pediatrician; seth G S Medical colllege
KEM Hospital - Parel/Bhabha Hospital - Bandra
Mumbai
for parents*more about me* Caring for kids*Yahoogroups Paediatrics*

for pediatricians : clinical tips

2006-04-28T23:29:00.000-07:00

for pediatricians
for pediatricians

06/08/2003

There is nothing called an emergency intubation?: TIP:not resistance but lack of some precaution on your part.; YES!! Just be confident in AMBU BMV, infact you should never hurry for intubation, unless you achieve a good chest rise and good color/spo2 on AMBU. BMV is the standard safest and most effective mode of mechanical ventilation. If you hurry for intubation, I am sure you will land up in complications. You always have enough time to plan an emergency intubation, give atropine and sedation and to chose the proper tube size.

--------------------------------------------------------------------------------

06/07/2003

Most of my patients with fever chills, who I send home on chloroquine; they come back within 24 hrs saying no effext! Is it chloroquine resistance?: TIP:not resistance but lack of some precaution on your part.; See it takes at least 26 hrs to get control over fever after starting chloroquine. If you had taken time to tell pt that fever may recur in 36 hrs, he wouldnt come to you at the next spike of fever. Also some other imp points which you need to tell him are: Shivering/sweating is nothing to worry (!), blankets may aggrevate temp.; Vomitting may be common following tablets. (Why dont you habituate yourself to give the first dose of chloroquine in hospital itself?. Its prefered that it should be given with food but even glucon D suffices; also countering the hypoglycemia effect)
Delete It Cancel

how to inject medicines to babies?

2006-03-14T09:05:00.000-08:00

funny

<3 yrs: I recommend child in mothers arm, immobilised... while one injects in thigh or butts.

3yr and above : no amount of counselling helps. Just inform that he may be given an injection which may not pain if he cooperates. Then apply restrain and finish the procedure in shortest time without the kid realising most of it.

===============================================

The maximum pain occurs when the chemical brushes with cut nerve endings.

SO:

use a separate needle to inject.

and when you withdraw needle out, let it be in shortest time span ( preferably with a jerk... rather than slow removal that pains alot).

injecting medicine in... slow or fast usually doesnt much affect duration or intensity of pain...( u r in painless intermuscular or fascial plain)

avoiding bony sites and periosteal injury will be preferable. ( so prefer bulk of muscle... dont hurry to inject)

oral/RT rehydration is almost as efficacious as parenteral, provided the feeding is supervised despit vomitting and sepsis is ruled out.

2006-03-13T05:38:00.000-08:00

for pediatriciansoral/RT rehydration is almost as efficacious as parenteral, provided the feeding is supervised despit vomitting and sepsis is ruled out.

Re: paediatrics yahoo case discussion: query

2006-02-19T10:00:00.000-08:00

Dear collegue:

My first impression after read this was an infection due to pertussis in an unvaccinated children or an inmunosupression secondary to acute leukemia, but these entities had some details in the clinical exam, labs o history hardly to hide, so I did a fast search on pubmed and these are my results: Pneumonia AND Leucocytosis

-Its more linked to pertussis, after mycoplasma or EBV

-Leukemoid reaction is a bad prognostic finding, independent of the causal agent.

Juan Pablo Chalco O MD

Pediatrician

Items 1 - 127 of 127

One page.

1:	De Berry BB, Lynch JE, Chung DH, Zwischenberger JB.	Related Articles, Links
	Pertussis with severe pulmonary hypertension and leukocytosis treated with extracorporeal membrane oxygenation. Pediatr Surg Int. 2005 Aug;21(8):692-4. Epub 2005 Oct 13. PMID: 15937656 [PubMed - indexed for MEDLINE]

2:	Brown L, Shaw T, Wittlake WA.	Related Articles, Links
	Does leucocytosis identify bacterial infections in febrile neonates presenting to the emergency department? Emerg Med J. 2005 Apr;22(4):256-9. PMID: 15788823 [PubMed - indexed for MEDLINE]

3:	Butler KL, Best IM, Oster RA, Katon-Benitez I, Lynn Weaver W, Bumpers HL.	Related Articles, Links
	Is bilateral protected specimen brush sampling necessary for the accurate diagnosis of ventilator-associated pneumonia? J Trauma. 2004 Aug;57(2):316-22. PMID: 15345979 [PubMed - indexed for MEDLINE]

4:	Sawalha W, Ahmad M.	Related Articles, Links
	Bilateral pleural empyema following periodontal abscess. East Mediterr Health J. 2001 Jul-Sep;7(4-5):852-4. No abstract available. PMID: 15332792 [PubMed - indexed for MEDLINE]

5:	Heininger U.	Related Articles, Links
	Comment on findings of Hodge et al. Respirology. 2004 Mar;9(1):141; author reply 142. No abstract available. PMID: 14982618 [PubMed - indexed for MEDLINE]

6:	Binstadt BA, Caldas AM, Turvey SE, Stone KD, Weinstein HJ, Jackson J, Fuhlbrigge RC, Sundel RP.	Related Articles, Links
	Rituximab therapy for multisystem autoimmune diseases in pediatric patients. J Pediatr. 2003 Nov;143(5):598-604. Erratum in: J Pediatr. 2004 Apr;144(4):558. PMID: 14615729 [PubMed - indexed for MEDLINE]

7:	Sit SC, Yau EK, Lam YY, Ng DK, Fong NC, Hui YW, Cheng WF, Leung CW, Chiu MC.	Related Articles, Links
	A young infant with severe acute respiratory syndrome. Pediatrics. 2003 Oct;112(4):e257. PMID: 14523208 [PubMed - indexed for MEDLINE]

8:	Goedvolk CA, von Rosenstiel IA, Bos AP.	Related Articles, Links
	Immune complex associated complications in the subacute phase of meningococcal disease: incidence and literature review. Arch Dis Child. 2003 Oct;88(10):927-30. Review. PMID: 14500317 [PubMed - indexed for MEDLINE]

9:	Pilorget H, Montbrun A, Attali T, Tiran-Rajaofera I, Bony C, Brayer C, Samperiz S, Alessandri JL.	Related Articles, Links
	[Malignant pertussis in the young infant] Arch Pediatr. 2003 Sep;10(9):787-90. French. PMID: 12972206 [PubMed - indexed for MEDLINE]

10:	Hodge G, Hodge S, Markus C, Lawrence A, Han P.	Related Articles, Links
	A marked decrease in L-selectin expression by leucocytes in infants with Bordetella pertussis infection: leucocytosis explained? Respirology. 2003 Jun;8(2):157-62. PMID: 12753529 [PubMed - indexed for MEDLINE]

11:	Chirinos JA, Lichtstein DM, Garcia J, Tamariz LJ.	Related Articles, Links
	The evolution of Lemierre syndrome: report of 2 cases and review of the literature. Medicine (Baltimore). 2002 Nov;81(6):458-65. Review. PMID: 12441902 [PubMed - indexed for MEDLINE]

12:	Smith C, Taylor D.	Related Articles, Links
	Quieting the '100-day cough'. A primer on pertussis. Adv Nurse Pract. 2000 Oct;8(10):60-2. No abstract available. PMID: 11761540 [PubMed - indexed for MEDLINE]

13:	Pierce C, Klein N, Peters M.	Related Articles, Links
	Is leukocytosis a predictor of mortality in severe pertussis infection? Intensive Care Med. 2000 Oct;26(10):1512-4. PMID: 11126265 [PubMed - indexed for MEDLINE]

14:	Garcia-Perez A, Espino M, Barrio A, Echavarri F, Bonet B, Bueno M, Yanguela J.	Related Articles, Links
	[Pseudotumor cerebri associated with maxillary sinusitis: clinico-pathological study] Rev Neurol. 2000 Jul 1-15;31(1):45-8. Spanish. PMID: 10948583 [PubMed - indexed for MEDLINE]

15:	Hudnall SD, Molina CP.	Related Articles, Links
	Marked increase in L-selectin-negative T cells in neonatal pertussis. The lymphocytosis explained? Am J Clin Pathol. 2000 Jul;114(1):35-40. PMID: 10884797 [PubMed - indexed for MEDLINE]

16:	Lee B.	Related Articles, Links
	Progressive respiratory distress in an infant treated for presumed pertussis. Pediatr Infect Dis J. 2000 May;19(5):475, 492-3. No abstract available. PMID: 10819348 [PubMed - indexed for MEDLINE]

17:	von Rosenstiel IA, Plotz FB.	Related Articles, Links
	ECLS in pertussis: does it have a role? Intensive Care Med. 1999 Nov;25(11):1341-2. No abstract available. PMID: 10654231 [PubMed - indexed for MEDLINE]

18:	Panacek EA.	Related Articles, Links
	Occult pneumonias in febrile children with leukocytosis. Ann Emerg Med. 1999 Nov;34(5):683-4. No abstract available. PMID: 10533022 [PubMed - indexed for MEDLINE]

19:	Baraff LJ.	Related Articles, Links
	Empiric chest radiographs in febrile children with leukocytosis. Ann Emerg Med. 1999 Apr;33(4):480. No abstract available. PMID: 10092739 [PubMed - indexed for MEDLINE]

20:	Bobrov VM, Shishkin SA.	Related Articles, Links
	[Middle mass molecules as an indicator of intoxication in the purulent inflammatory ENT diseases] Vestn Otorinolaringol. 1999;(1):33-4. Russian. PMID: 10081416 [PubMed - indexed for MEDLINE]

21:	Bachur R, Perry H, Harper MB.	Related Articles, Links
	Occult pneumonias: empiric chest radiographs in febrile children with leukocytosis. Ann Emerg Med. 1999 Feb;33(2):166-73. PMID: 9922412 [PubMed - indexed for MEDLINE]

22:	Green SM, Rothrock SG.	Related Articles, Links
	Evaluation styles for well-appearing febrile children: are you a "risk-minimizer" or a "test-minimizer"? Ann Emerg Med. 1999 Feb;33(2):211-4. No abstract available. PMID: 9922418 [PubMed - indexed for MEDLINE]

23:	Heininger U, Klich K, Stehr K, Cherry JD.	Related Articles, Links
	Clinical findings in Bordetella pertussis infections: results of a prospective multicenter surveillance study. Pediatrics. 1997 Dec;100(6):E10. PMID: 9382911 [PubMed - indexed for MEDLINE]

24:	Fishback N, Koss M.	Related Articles, Links
	Update on lymphoid interstitial pneumonitis. Curr Opin Pulm Med. 1996 Sep;2(5):429-33. Review. PMID: 9363179 [PubMed - indexed for MEDLINE]

25:	McCarthy VP, Carlile JR.	Related Articles, Links
	Hyperleukocytosis with pertussis. J Assoc Acad Minor Phys. 1997;8(3):52-4. PMID: 9271891 [PubMed - indexed for MEDLINE]

26:	Solomon KS, Levin TL, Berdon WE, Romney B, Ruzal-Shapiro C, Bye MR.	Related Articles, Links
	Pneumothorax as the presenting sign of Pneumocystis carinii infection in an HIV-positive child with prior lymphocytic interstitial pneumonitis. Pediatr Radiol. 1996;26(8):559-62. PMID: 8753672 [PubMed - indexed for MEDLINE]

27:	Akintunde EO, Shokunbi WA, Adekunle CO.	Related Articles, Links
	Leucocyte count, platelet count and erythrocyte sedimentation rate in pulmonary tuberculosis. Afr J Med Med Sci. 1995 Jun;24(2):131-4. PMID: 8669390 [PubMed - indexed for MEDLINE]

28:	Hertenstein B, Hampl W, Bunjes D, Wiesneth M, Duncker C, Koszinowski U, Heimpel H, Arnold R, Mertens T.	Related Articles, Links
	In vivo/ex vivo T cell depletion for GVHD prophylaxis influences onset and course of active cytomegalovirus infection and disease after BMT. Bone Marrow Transplant. 1995 Mar;15(3):387-93. PMID: 7599563 [PubMed - indexed for MEDLINE]

29:	Hotz P, Loos U, Luderitz B.	Related Articles, Links
	[Lymphocyte subpopulations in bronchoalveolar lavage fluid in AIDS] Dtsch Med Wochenschr. 1994 Mar 4;119(9):289-95. German. PMID: 8119108 [PubMed - indexed for MEDLINE]

30:	Yetgin S, Ozbek N, Tuncer M, Gocmen A, Ozcelik U.	Related Articles, Links
	Kostmann's syndrome with chronic pneumonia and lymphocytosis: effect of recombinant human G-CSF. Turk J Pediatr. 1994 Jan-Mar;36(1):87-91. PMID: 7514821 [PubMed - indexed for MEDLINE]

31:	Matsuo M, Hara T, Ura Y, Motoyama K, Miyazaki S.	Related Articles, Links
	Measles without rash in an infant with pertussis. Acta Paediatr Jpn. 1993 Dec;35(6):541. No abstract available. PMID: 8109236 [PubMed - indexed for MEDLINE]

32:	Constans J, Ladner J, Dabis F, Brossard G, Commenges D, Leng B, Conri C.	Related Articles, Links
	[CD8 hyperlymphocytosis in HIV infection. 63 cases. GECSA (Groupe d'Epidemiologie Clinique du SIDA en Aquitaine)] Presse Med. 1992 Jan 4-11;21(1):27-30. French. PMID: 1531260 [PubMed - indexed for MEDLINE]

33:	Cotton JB, Bronner J, Durra A, Abeille A, Barnouin L, Berthier JC.	Related Articles, Links
	[Diffuse alveolar pertussis with major hyperleukocytosis with "pseudocentrocytic" contingent] Pediatrie. 1992;47(2):117-20. French. PMID: 1319026 [PubMed - indexed for MEDLINE]

34:	Teravanichpong S, Chuangsuwanich T.	Related Articles, Links
	Fatal varicella in a healthy girl. J Med Assoc Thai. 1990 Nov;73(11):648-51. PMID: 2283495 [PubMed - indexed for MEDLINE]

35:	Shann F, Barker J, Poore P.	Related Articles, Links
	Clinical signs that predict death in children with severe pneumonia. Pediatr Infect Dis J. 1989 Dec;8(12):852-5. PMID: 2696926 [PubMed - indexed for MEDLINE]

36:	Zielonka TM, Grubek-Jaworska H, Walajtys-Rode E, Orlowska K, Droszcz W.	Related Articles, Links
	[A case of lymphoid interstitial pneumonia] Pneumonol Pol. 1989 Jul-Sep;57(7-9):420-5. Polish. PMID: 2636373 [PubMed - indexed for MEDLINE]

37:	Bonadio WA.	Related Articles, Links
	Bacteremia in febrile children with lobar pneumonia and leukocytosis. Pediatr Emerg Care. 1988 Dec;4(4):241-2. PMID: 3231554 [PubMed - indexed for MEDLINE]

38:	Holting T, Sievers U, Kaeselitz J.	Related Articles, Links
	[Changes in morbidity following traumatologically-induced splenectomy] Aktuelle Traumatol. 1988 Feb;18(1):51-4. German. PMID: 2896438 [PubMed - indexed for MEDLINE]

39:	Marshall GS, Edwards KM, Butler J, Lawton AR.	Related Articles, Links
	Syndrome of periodic fever, pharyngitis, and aphthous stomatitis. J Pediatr. 1987 Jan;110(1):43-6. PMID: 3794885 [PubMed - indexed for MEDLINE]

40:	Sorensen RU, Abramowsky CR, Stern RC.	Related Articles, Links
	Ten-year course of early-onset Weber-Christian syndrome with recurrent pneumonia: a suggestion for pathogenesis. Pediatrics. 1986 Jul;78(1):115-20. PMID: 3725481 [PubMed - indexed for MEDLINE]

41:	Larchet M, Freymuth F, Duhamel JF, Vergnaud M, Quibriac M.	Related Articles, Links
	[Fast diagnosis of whooping cough in the infant. Contribution of the immunofluorescence technic] Arch Fr Pediatr. 1986 Mar;43(3):175-8. French. PMID: 2875698 [PubMed - indexed for MEDLINE]

42:	Shenderova RI, Osina NA.	Related Articles, Links
	[Types of group-specific proteins, ceruloplasmin and transferrin in pulmonary tuberculosis patients] Probl Tuberk. 1986;(9):50-3. Russian. No abstract available. PMID: 3786320 [PubMed - indexed for MEDLINE]

43:	Allegretta GJ, Weisman SJ, Altman AJ.	Related Articles, Links
	Oncologic emergencies II. Hematologic and infectious complications of cancer and cancer treatment. Pediatr Clin North Am. 1985 Jun;32(3):613-24. PMID: 3873638 [PubMed - indexed for MEDLINE]

44:	Bertotto A, Forenza N, Peirone AP, Mazzarino I, Vaccaro R.	Related Articles, Links
	T-cell subsets in children with pertussis. Haematologica. 1984 May-Jun;69(3):342-5. No abstract available. PMID: 6432647 [PubMed - indexed for MEDLINE]

45:	De Martino M, Rossi ME, Muccioli AT, Ulivelli A, Vierucci A.	Related Articles, Links
	Preferential increase of a T-cell subset as a cause of lymphocytosis in children with whooping cough. Boll Ist Sieroter Milan. 1984;63(5):479-82. PMID: 6335661 [PubMed - indexed for MEDLINE]

46:	Lafitte JJ, Steenhouwer F, Roussel M, Courcol R, Voisin C, Caillaux M, Debosker Y, Geslin P.	Related Articles, Links
	[Kinetics of the local immune response in lobar pneumonia] Bull Eur Physiopathol Respir. 1983 Mar-Apr;19(2):209-13. French. PMID: 6871500 [PubMed - indexed for MEDLINE]

47:	Saumur JH.	Related Articles, Links
	Hematology problem: pertussis. Am J Med Technol. 1983 Mar;49(3):169-70. No abstract available. PMID: 6340501 [PubMed - indexed for MEDLINE]

48:	Aronson MD, Komaroff AL, Pass TM, Ervin CT, Branch WT.	Related Articles, Links
	Heterophil antibody in adults with sore throat: frequency and clinical presentation. Ann Intern Med. 1982 Apr;96(4):505-8. PMID: 6895981 [PubMed - indexed for MEDLINE]

49:	Krylov AA, Dmitriev VI.	Related Articles, Links
	[Tonsillogenic reactive polyadenitis and leukemoid reactions in young people] Voen Med Zh. 1982 Jan;(1):62-4. Russian. No abstract available. PMID: 7058657 [PubMed - indexed for MEDLINE]

50:	McGeady SJ, Murphey SA.	Related Articles, Links
	Disseminated Mycobacterium kansasii infection. Clin Immunol Immunopathol. 1981 Jul;20(1):87-98. No abstract available. PMID: 6455228 [PubMed - indexed for MEDLINE]

51:	Matsuhashi Y.	Related Articles, Links
	[Studies on lymphocytes associated with pertussis infection and vaccination. Analysis of lymphocyte subpopulation (author's transl)] Kansenshogaku Zasshi. 1980 Aug;54(8):383-95. Japanese. No abstract available. PMID: 6782177 [PubMed - indexed for MEDLINE]

52:	Ward PC.	Related Articles, Links
	The lymphoid leukocytoses. Postgrad Med. 1980 Feb;67(2):217-23. PMID: 7352124 [PubMed - indexed for MEDLINE]

53:	Prusek W, Jankowski A.	Related Articles, Links
	Some aspects of humoral and cellular immunity in children suffering from spastic bronchitis. Arch Immunol Ther Exp (Warsz). 1980;28(1):53-9. PMID: 6968194 [PubMed - indexed for MEDLINE]

54:	Shann F, Germer S.	Related Articles, Links
	Leukaemoid reaction in Eastern Highlands children. P N G Med J. 1979 Dec;22(4):55-7. PMID: 299330 [PubMed - indexed for MEDLINE]

55:	Tsai TF, Finn DR, Plikaytis BD, McCauley W, Martin SM, Fraser DW.	Related Articles, Links
	Legionnaires' disease: clinical features of the epidemic in Philadelphia. Ann Intern Med. 1979 Apr;90(4):509-17. PMID: 434627 [PubMed - indexed for MEDLINE]

56:	Buchs S.	Related Articles, Links
	[Significance of blood sedimentation for diagnosis of pertussis] Dtsch Med Wochenschr. 1978 Mar 10;103(10):399-400. German. No abstract available. PMID: 639652 [PubMed - indexed for MEDLINE]

57:	Botvin'ev VV, Baranova NF, Sterligov LA.	Related Articles, Links
	[T- and B-immunity systems in acute respiratory and allergic diseases of the respiratory organs in children] Vestn Akad Med Nauk SSSR. 1978;(7):24-9. Russian. No abstract available. PMID: 307880 [PubMed - indexed for MEDLINE]

58:	Handzel ZT, Levin S, Ashkenazi A, Hahn T, Altman Y, Czernobilsky B, Shechter B, Trainin N.	Related Articles, Links
	Immune deficiency of T system with possible T cell regulatory activity defect. Isr J Med Sci. 1977 Apr;13(4):347-53. PMID: 194869 [PubMed - indexed for MEDLINE]

59:	Weintraub MI.	Related Articles, Links
	External ophthalmoplegia, ataxia, and areflexia complicating acute infectious polyneuritis. Am J Ophthalmol. 1977 Mar;83(3):355-7. PMID: 848540 [PubMed - indexed for MEDLINE]

60:	Malleson PN, Bennett JC.	Related Articles, Links
	Whooping-cough admissions to a paediatric hospital over ten years. The protective value of immunisation. Lancet. 1977 Jan 29;1(8005):237-9. PMID: 64762 [PubMed - indexed for MEDLINE]

61:	Erben W, Ebert H.	Related Articles, Links
	[Relationship between age and inflammatory reaction following mitral commissurotomy] ZFA. 1977;32(2):41-5. German. PMID: 919582 [PubMed - indexed for MEDLINE]

62:	Tacu V, Cdun-Tarabutta G, Dascalu M, Nastasa V, Alexa M.	Related Articles, Links
	[Biological changes in the course of acute microbial bronchopneumopathies. II.] Rev Med Chir Soc Med Nat Iasi. 1977 Jan-Mar;81(1):23-7. Romanian. No abstract available. PMID: 866833 [PubMed - indexed for MEDLINE]

63:	Bernales R, Eastman J, Kaplan J.	Related Articles, Links
	Quantitation of circulating T and B lymphocytes in children with whooping cough. Pediatr Res. 1976 Dec;10(12):965-7. PMID: 1087001 [PubMed - indexed for MEDLINE]

64:	Begue P, Lasfargues G, Omanga U.	Related Articles, Links
	[Respiratory infections due to Mycoplasma pneumoniae] Ann Pediatr (Paris). 1976 Jan 2;23(1):43-6. French. No abstract available. PMID: 16104250 [PubMed - indexed for MEDLINE]

65:	Morse SI.	Related Articles, Links
	Biologically active components and properties of Bordetella pertussis. Adv Appl Microbiol. 1976;20:9-26. No abstract available. PMID: 11644 [PubMed - indexed for MEDLINE]

66:	Bachi C, Jona E, Botta G.	Related Articles, Links
	[Some cases of lymphomonocytosis and atypical immunological syndromes] Minerva Med. 1975 Jun 20;66(45):2212-6. Italian. No abstract available. PMID: 1143704 [PubMed - indexed for MEDLINE]

67:	Hoagland RJ.	Related Articles, Links
	Infectious mononucleosis. Prim Care. 1975 Jun;2(2):295-307. PMID: 1046252 [PubMed - indexed for MEDLINE]

68:	Vietti TJ, Ragab AH.	Related Articles, Links
	Complications and total care of a child with acute leukemia. Cancer. 1975 Mar;35(3 suppl):1007-14. PMID: 1167484 [PubMed - indexed for MEDLINE]

69:	Chervenick PA.	Related Articles, Links
	Infectious mononucleosis. Dis Mon. 1974 Dec;:1-29. Review. No abstract available. PMID: 4373218 [PubMed - indexed for MEDLINE]

70:	Eule H, Werner E, Winsel K, Iwainsky H.	Related Articles, Links
	Intermittent chemotherapy of pulmonary tuberculosis using rifampicin and isoniazid for primary treatment: the influence of various factors on the frequency of side-effects. Tubercle. 1974 Mar;55(1):81-9. Review. No abstract available. PMID: 4620295 [PubMed - indexed for MEDLINE]

71:	Behan PO, Moore MJ, Lamarche JB.	Related Articles, Links
	Acute necrotizing hemorrhagic encephalopathy. Postgrad Med. 1973 Oct;54(4):154-60. No abstract available. PMID: 4125731 [PubMed - indexed for MEDLINE]

72:	Andriushchenko TM.	Related Articles, Links
	[Significance of leukocytosis, antihistamine factor and tuberculin hemolysis in the diagnosis of tuberculosis] Vrach Delo. 1973 Aug;8:8-12. Russian. No abstract available. PMID: 4149202 [PubMed - indexed for MEDLINE]

73:	Nimis R.	Related Articles, Links
	[Presence of unusual cellular elements in the circulating blood (in some cases of acute diseases of various etiology)] Minerva Med. 1973 May 27;64(38):2035-47. Italian. No abstract available. PMID: 4737076 [PubMed - indexed for MEDLINE]

74:	Novis BH, Bank S, Marks IN.	Related Articles, Links
	Gastro-intestinal and peritoneal tuberculosis. A study of cases at Groote Schuur Hospital 1962-1971. S Afr Med J. 1973 Mar 3;47(9):365-72. No abstract available. PMID: 4690394 [PubMed - indexed for MEDLINE]

75:	Steinitz H.	Related Articles, Links
	[Results of clinical trials with cephadrine in children] Infection. 1973;1(3):163-9. German. No abstract available. PMID: 4597099 [PubMed - indexed for MEDLINE]

76:	Fernbach DJ, Starling KA.	Related Articles, Links
	Infectious mononucleosis. Pediatr Clin North Am. 1972 Nov;19(4):957-68. Review. No abstract available. PMID: 4343069 [PubMed - indexed for MEDLINE]

77:	Ishchenko IK, Orlov OV.	Related Articles, Links
	[Characteristics of the course of acute pneumonia in young persons] Voen Med Zh. 1972 Oct;10:77-8. Russian. No abstract available. PMID: 4669169 [PubMed - indexed for MEDLINE]

78:	Dietzsch HJ, Wunderlich P, Potschick G, Frey G.	Related Articles, Links
	[Abscessed (staphylococcal) pneumonia in childhood] Z Arztl Fortbild (Jena). 1972 Sep 1;66(17):863-8. German. No abstract available. PMID: 4118084 [PubMed - indexed for MEDLINE]

79:	Park S, Giammona ST.	Related Articles, Links
	Toxic effects of tear gas on an infant following prolonged exposure. Am J Dis Child. 1972 Mar;123(3):245-6. No abstract available. PMID: 4554617 [PubMed - indexed for MEDLINE]

80:	Zinov'ev IP, Dibeeva LM.	Related Articles, Links
	[Hyperleukocytosis in fibro-cavitary pulmonary tuberculosis] Probl Tuberk. 1972;50(1):60-3. Russian. No abstract available. PMID: 5010784 [PubMed - indexed for MEDLINE]

81:	Kaluza P.	Related Articles, Links
	[Slowly-resolving and persistent pneumonias--differentiation of non-contagious tuberculosis and bronchial carcinoma] Z Erkr Atmungsorgane Folia Bronchol. 1972;137(1):17-33. German. No abstract available. PMID: 4486577 [PubMed - indexed for MEDLINE]

82:	Justus J, Heyne K.	Related Articles, Links
	[Pathological-anatomical and clinical findings in progressive septic granulomatous disease in infants] Acta Paediatr Acad Sci Hung. 1972;13(4):377-86. German. No abstract available. PMID: 4268903 [PubMed - indexed for MEDLINE]

83:	Naeye RL, Dellinger WS, Blanc WA.	Related Articles, Links
	Fetal and maternal features of antenatal bacterial infections. J Pediatr. 1971 Nov;79(5):733-9. No abstract available. PMID: 5000610 [PubMed - indexed for MEDLINE]

84:	Caul EO, Mott MG, Clarke SK, Perham TG, Wilson RS.	Related Articles, Links
	Cytomegalovirus infections after open heart surgery. A prospective study. Lancet. 1971 Apr 17;1(7703):777-80. No abstract available. PMID: 4101275 [PubMed - indexed for MEDLINE]

85:	Arndt HJ.	Related Articles, Links
	[Fulminating epiglottitis in children. Report on 50 cases] Dtsch Med Wochenschr. 1971 Apr 2;96(14):569-77. German. No abstract available. PMID: 5548854 [PubMed - indexed for MEDLINE]

86:	Burke JP, Klein JO, Gezon HM, Finland M.	Related Articles, Links
	Pneumococcal bacteremia. Review of 111 cases, 1957--1969, with special reference to cases with undetermined focus. Am J Dis Child. 1971 Apr;121(4):353-9. Review. No abstract available. PMID: 4396753 [PubMed - indexed for MEDLINE]

87:	Lampkin BC, Mauer AM.	Related Articles, Links
	Clinical manifestations of visceral larva migrans. Variability as related to duration of ingestion. Clin Pediatr (Phila). 1970 Nov;9(11):683-5. No abstract available. PMID: 5477280 [PubMed - indexed for MEDLINE]

88:	Verin P.	Related Articles, Links
	[Infectious pathology. II. Viral pathology] Arch Ophtalmol Rev Gen Ophtalmol. 1970 May;30(5):437-52. Review. French. No abstract available. PMID: 4316940 [PubMed - indexed for MEDLINE]

89:	Goudemand M, Bauters F, Leduc M, Tacquet A, Devulder B, Debruyne J.	Related Articles, Links
	[Generalized mycobacteriosis with hematologic manifestations (fatal infection with Mycobacterium kansasii with myeloid type, leukemoid reaction)] Rev Tuberc Pneumol (Paris). 1970 Mar;34(2):225-46. French. No abstract available. PMID: 5510313 [PubMed - indexed for MEDLINE]

90:	Kostyshin AT.	Related Articles, Links
	[Migration of leukocytes to the surface of the palatine tonsils in tonsillitis] Zh Ushn Nos Gorl Bolezn. 1970 Mar-Apr;30(2):76-80. Russian. No abstract available. PMID: 5496049 [PubMed - indexed for MEDLINE]

91:	Breson K, Diepeveen J.	Related Articles, Links
	Dissection tonsillectomy--complications and follow-up. J Laryngol Otol. 1969 Jun;83(6):601-8. No abstract available. PMID: 5254391 [PubMed - indexed for MEDLINE]

92:	Leigh PG.	Related Articles, Links
	Appendicitis--still a considerable problem. S Afr Med J. 1969 May 31;43(22):700-5. No abstract available. PMID: 5786237 [PubMed - indexed for MEDLINE]

93:	Guignard J, Rousseau L, Le Gouas JJ.	Related Articles, Links
	[Pneumopathies in children due to ingestion of petroleum] Ann Pediatr (Paris). 1969 Apr 2;16(4):284-9. French. No abstract available. PMID: 5800640 [PubMed - indexed for MEDLINE]

94:	Kowal-Gierczak B, Kuczynska-Sekieta K, Dolinska G, Falowska-Adamczyk W, Szott M.	Related Articles, Links
	[Some biochemical changes in patients with post-influenzal complications] Przegl Lek. 1969;25(12):793-6. Polish. No abstract available. PMID: 5367980 [PubMed - indexed for MEDLINE]

95:	Fujii K.	Related Articles, Links
	Studies on lymphocytosis induced by Hemophilus pertussis. 3. Clinical studies: observations of peripheral blood and cultured lymphocytes in vitro. Hiroshima J Med Sci. 1968 Dec;17(4):261-83. No abstract available. PMID: 4307309 [PubMed - indexed for MEDLINE]

96:	Calcaterra TC.	Related Articles, Links
	An evaluation of the treatment of subglottic hemangioma. Laryngoscope. 1968 Nov;78(11):1956-64. No abstract available. PMID: 5755027 [PubMed - indexed for MEDLINE]

97:	Al'tman EM, Katkova LS.	Related Articles, Links
	[On the interrelation between chronic tonsillitis and acute appendicitis in children] Pediatriia. 1968 May;47(5):62-4. Russian. No abstract available. PMID: 5713344 [PubMed - indexed for MEDLINE]

98:	Kocoglu V.	Related Articles, Links
	[Acute infectious lymphocytosis] Kinderarztl Prax. 1968 Mar;36(3):105-8. German. No abstract available. PMID: 5715780 [PubMed - indexed for MEDLINE]

99:	Men'shikova NL, Sintosova GG.	Related Articles, Links
	[Infectious lymphocytosis in children with tuberculosis] Probl Tuberk. 1968;46(5):82-3. Russian. No abstract available. PMID: 5708505 [PubMed - indexed for MEDLINE]

100:	Shakhnovich LA.	Related Articles, Links
	[On the reaction of local (comparative) leukocytosis] Lab Delo. 1968;9:573-4. Russian. No abstract available. PMID: 4184969 [PubMed - indexed for MEDLINE]

101:	Collins JO, Rosenberg HA, Warren P.	Related Articles, Links
	Disseminated pathergic granulomatosis in a 4-month-old infant: a case report. Pediatrics. 1967 Dec;40(6):975-9. No abstract available. PMID: 6074137 [PubMed - indexed for MEDLINE]

102:	Kjellman B.	Related Articles, Links
	Bronchial asthma and recurrent pneumonia in children. Clinical evaluation of 14 children. Acta Paediatr Scand. 1967 Nov;56(6):651-9. No abstract available. PMID: 4169523 [PubMed - indexed for MEDLINE]

103:	Brooksaler F, Nelson JD.	Related Articles, Links
	Pertussis. A reappraisal and report of 190 confirmed cases. Am J Dis Child. 1967 Oct;114(4):389-96. No abstract available. PMID: 6047238 [PubMed - indexed for MEDLINE]

104:	Skarberg KO, Lagerlof B, Reizenstein P.	Related Articles, Links
	Leukaemia, leukaemoid reaction and tuberculosis. Acta Med Scand. 1967 Oct;182(4):427-32. No abstract available. PMID: 5234000 [PubMed - indexed for MEDLINE]

105:	Johnston RB Jr, McMurry JS.	Related Articles, Links
	Chronic familial granulomatosis. Report of five cases and review of the literature. Am J Dis Child. 1967 Oct;114(4):370-8. No abstract available. PMID: 4167307 [PubMed - indexed for MEDLINE]

106:	Ambs E, Koch WR.	Related Articles, Links
	[On the diagnostic value of the white blood count in the convulsive stage of whooping cough] Z Kinderheilkd. 1967;100(4):331-42. German. No abstract available. PMID: 5596638 [PubMed - indexed for MEDLINE]

107:	Shengeliia AA.	Related Articles, Links
	[Comparative evaluation of Wunderlich's triad, ESR indexes and leukocytosis in children with pneumonia] Pediatriia. 1966 Apr;45(4):66-7. Russian. No abstract available. PMID: 5985085 [PubMed - indexed for MEDLINE]

108:	Shnaider LA, Dzhikiia NI.	Related Articles, Links
	[The blood picture in chronic and recurrent forms of pneumonia in young children] Pediatriia. 1966 Mar;45(3):44-8. Russian. No abstract available. PMID: 5974304 [PubMed - indexed for MEDLINE]

109:	Liebscher S, Wunderlich P.	Related Articles, Links
	[A case of facial paralysis caused by adenovirus type 5 infection] Dtsch Med Wochenschr. 1966 Feb 11;91(6):256-9. German. No abstract available. PMID: 4285741 [PubMed - indexed for MEDLINE]

110:	Ambs E.	Related Articles, Links
	[On the characterization of pertussis lymphocytes in the peripheral blood] Ann Paediatr. 1966;206(2):120-34. German. No abstract available. PMID: 5953109 [PubMed - indexed for MEDLINE]

111:	Ferrari M.	Related Articles, Links
	[Febrile, lymphocytic and hypergammaglobulin syndrome] Prensa Med Argent. 1966;53(1):361-3. Spanish. No abstract available. PMID: 4168487 [PubMed - indexed for MEDLINE]

112:	PEDOYA C, GIRIER L, MICHALLET M, DISCAMPS C.	Related Articles, Links
	[VALUE OF THE ORAL ADMINISTRATION OF CLOMETHOCILLIN IN THE TREATMENT OF INFECTIONS DUE TO PENICILLIN-SENSITIVE BACTERIA.] Presse Med. 1965 Apr 24;73:1219-20. French. No abstract available. PMID: 14273899 [PubMed - OLDMEDLINE for Pre1966]

113:	GREWE HE, MARTINI-PAPE M.	Related Articles, Links
	[PURULENT MEDIASTINITIS IN EARLY INFANCY.] Kinderarztl Prax. 1964 Jul;32:305-14. German. No abstract available. PMID: 14252840 [PubMed - OLDMEDLINE for Pre1966]

114:	DREYFUS B.	Related Articles, Links
	[PRACTICAL INTERPRETATION OF BLOOD LYMPHOCYTOSIS.] Rev Prat. 1964 May 1;14:1673-81. French. No abstract available. PMID: 14147342 [PubMed - OLDMEDLINE for Pre1966]

115:	FLEISCHHACKER H, STACHER A.	Related Articles, Links
	[REACTIONS OF BLOOD LYMPHOCYTES.] Med Klin. 1964 Mar 6;59:382-5. German. No abstract available. PMID: 14176487 [PubMed - OLDMEDLINE for Pre1966]

116:	OLSON LC, MILLER G, HANSHAW JB.	Related Articles, Links
	ACUTE INFECTIOUS LYMPHOCYTOSIS PRESENTING AS A PERTUSSIS-LIKE ILLNESS: ITS ASSOCIATION WITH ADENOVIRUS TYPE 12. Lancet. 1964 Jan 25;39:200-1. No abstract available. PMID: 14074503 [PubMed - OLDMEDLINE for Pre1966]

117:	MATTELAER PM, RILEY HD Jr.	Related Articles, Links
	LEUKEMIA IN THE PERINATAL PERIOD. Ann Paediatr. 1964;203:124-36. No abstract available. PMID: 14206837 [PubMed - OLDMEDLINE for Pre1966]

118:	DUBOIS J.	Related Articles, Links
	[PREVENTION BY PENICILLIN OF THE BACTERIAL COMPLICATIONS OF MEASLES IN CHILDREN.] Rev Med Liege. 1964 Jan 1;19:19-24. French. No abstract available. PMID: 14135986 [PubMed - OLDMEDLINE for Pre1966]

119:	WULFF H, KIDD P, WENNER HA.	Related Articles, Links
	ETIOLOGY OF RESPIRATORY INFECTIONS. FURTHER STUDIES DURING INFANCY AND CHILDHOOD. Pediatrics. 1964 Jan;33:30-44. No abstract available. PMID: 14115225 [PubMed - OLDMEDLINE for Pre1966]

120:	SHVALKO AD, MUKHINA TL.	Related Articles, Links
	[HEMATOLOGICAL CHANGES IN WHOOPING COUGH IN CHILDREN DURING THE FIRST MONTHS OF LIFE.] Vopr Okhr Materin Det. 1963 Oct;27:55-9. Russian. No abstract available. PMID: 14123225 [PubMed - OLDMEDLINE for Pre1966]

121:	KAPLAN AS, GAEVA LL, MAKARENKO GA.	Related Articles, Links
	[ANALYSIS OF AN OUTBRAKE OF ADENOVIRVUS DISEASES IN THE PEDIATRIC SECTION OF A TUBERCULOSIS SANATORIUM.] Pediatriia. 1963 Sep;42:23-7. Russian. No abstract available. PMID: 14088498 [PubMed - OLDMEDLINE for Pre1966]

122:	KRIUKOVA OF, KECHKINA ZS.	Related Articles, Links
	[ON ADENOVIRUS INFECTION IN CHILDREN.] Vopr Okhr Materin Det. 1963 Jul;90:81-2. Russian. No abstract available. PMID: 14069411 [PubMed - OLDMEDLINE for Pre1966]

123:	GOTTI D, GRAZIA G.	Related Articles, Links
	[INFECTIOUS MONONUCLEOSIS IN CHILDHOOD. FINDINGS OF A CLINICAL NATURE.] Clin Pediatr (Bologna). 1963 Apr;45:229-32. Italian. No abstract available. PMID: 14075309 [PubMed - OLDMEDLINE for Pre1966]

124:	SORENSEN H.	Related Articles, Links
	[Lymphocytic angina complicated by facial paralysis.] HNO. 1962 Mar;10:74-6. German. No abstract available. PMID: 13915267 [PubMed - OLDMEDLINE for Pre1966]

125:	HOFMEIER K.	Related Articles, Links
	[On the effects of long-term vitamin C administration on susceptible children and those with a lymphatic diathesis.] Med Nov. 1959 Nov 28;48:2351-5. German. No abstract available. PMID: 14402451 [PubMed - OLDMEDLINE for Pre1966]

126:	BINDER L, GOBEL Z.	Related Articles, Links
	[Lymphocytosis caused by pertussis.] Orv Hetil. 1958 Mar 30;99(13):442-4. Hungarian. No abstract available. PMID: 13553425 [PubMed - OLDMEDLINE for Pre1966]

127:	SZWALKIEWICZ O.	Related Articles, Links
	[Epidemic infectious lymphocytosis in Rabka.] Pediatr Pol. 1957 Apr;32(4):377-85. Polish. No abstract available. PMID: 13504927 [PubMed - OLDMEDLINE for Pre1966]

PaediatricsYahoogroups Dr Kondekar <drdoctor@hotmail.com> wrote:

hi all
I have a case to share, and would be glad to have expert opinion.

8 month baby presented on 26 feb with history of measles 10 days prior, and respiratory distress since then, xray after admission showed bilateral parahilar opacities closely resembling bronchopneumonia, counts were near normal, child was given supportive care, was discharged on oral amox-clav as a so called prophylaxis for preventing secondary bacterial infection ( I disagree). Complete XRC resolution was documented within 3 days of admission, child was discahrged on oral antibiotics. There was no fever documented since admission.

After 3-4 days, child had fever again.. she couldnt come to hospital over weekend, when she followed up on 6 th March with fever of almost 3 days high grade; there was no refusal to feeds, she refused admission for some reasons, she was sent home after changing antibiotics to oral cefixime as monitoring wasnt possible.

There was no relief with same medicines, she was readmitted on around feb 10, on admission... the same patch on Xrchest was obvious, child was having significant distress and there were bilateral crepts, with high fever, again responded to conservative therapy, fever responded to cefotaxim IV after 3 days of therapy, distress settled.
The interesting thing in this course was that... the counts

on admission 26 feb TC 12000 poly 62 Lympho33
on readmission on 10 march TC 55000 P73 L 25, rest atypical L cytes
after 8 days of antibiotic therapy.. TC 99000 P 60 L 37, rest attypical L cytes.

Can we discuss what exactly we were dealing with?

Dr kondekar santosh venketraman
child health specialist at HIS best!
9869803343
pediatrician; seth G S Medical colllege
KEM Hospital - Parel/Bhabha Hospital - Bandra
Mumbai

Visit us at : http://groups.yahoo.com/group/paediatrics http://drkondekar.s5.com/

SPONSORED LINKS

Pediatric Mesh

YAHOO! GROUPS LINKS

Visit your group "paediatrics" on the web.
To unsubscribe from this group, send an email to: mailto:paediatrics-unsubscribe@yahoogroups.com?subject=Unsubscribe
Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service.

Yahoo! Mail
Use Photomail to share photos without annoying attachments.

case discussion: query

2006-02-19T05:23:00.000-08:00

hi all
I have a case to share, and would be glad to have expert opinion.

8 month baby presented on 26 feb with history of measles 10 days prior, and respiratory distress since then, xray after admission showed bilateral parahilar opacities closely resembling bronchopneumonia, counts were near normal, child was given supportive care, was discharged on oral amox-clav as a so called prophylaxis for preventing secondary bacterial infection ( I disagree). Complete XRC resolution was documented within 3 days of admission, child was discahrged on oral antibiotics. There was no fever documented since admission.

After 3-4 days, child had fever again.. she couldnt come to hospital over weekend, when she followed up on 6 th March with fever of almost 3 days high grade; there was no refusal to feeds, she refused admission for some reasons, she was sent home after changing antibiotics to oral cefixime as monitoring wasnt possible.

There was no relief with same medicines, she was readmitted on around feb 10, on admission... the same patch on Xrchest was obvious, child was having significant distress and there were bilateral crepts, with high fever, again responded to conservative therapy, fever responded to cefotaxim IV after 3 days of therapy, distress settled.
The interesting thing in this course was that... the counts

on admission 26 feb TC 12000 poly 62 Lympho33
on readmission on 10 march TC 55000 P73 L 25, rest atypical L cytes
after 8 days of antibiotic therapy.. TC 99000 P 60 L 37, rest attypical L cytes.

Can we discuss what exactly we were dealing with?

Dr kondekar santosh venketraman
child health specialist at HIS best!
9869803343
pediatrician; seth G S Medical colllege
KEM Hospital - Parel/Bhabha Hospital - Bandra
Mumbai

tachycardia and tachypnea

2006-02-18T09:09:00.000-08:00

Table I - Tachycardia at rest
AgeApical Heart (Beats Per Minute)
Under 1 year . . . . .. 150
1 through 3 years . . . . 130
4 through 9 years . . . . 120
10 through 15 years . . . . 110
Over 15 years . . ` . 100

Table II - Tachypnea at rest

AgeRespiratory Rate Over (Per Minute)
Under 1 year. . . . . .. 40
1 through 5 years. . . . . 35
6 through 9 years. . . . . 30
Over 9 years. . . . 25

======================================

Dr kondekar santosh venketraman
child health specialist at HIS best!
9869803343
pediatrician; seth G S Medical colllege
KEM Hospital - Parel/Bhabha Hospital - Bandra
Mumbai

http://egee-na4.ct.infn.it/biomed/CDSS.html

2006-02-18T04:54:00.000-08:00

http://egee-na4.ct.infn.it/biomed/CDSS.html

Medical Error is actually the most important cause of death in the developing world. Medical Error implies actions such as the conclusion of a wrong diagnosis, the prescription of an incorrect treatment or the inefficient execution of a correct treatment. Main Medical Error cause however, is not located on a bad practice from the physician, but on the lack of different filters, which, as in other disciplines, detect problems and raise corrective measures.

One important filter for preventing Medical Error is Clinical Decision Support (CDS). CDS consist on the use of tools that guide the physicians in the diagnosis, selection of treatment or evaluation of a therapy. CDS do not substitute the physicians’ decision, but complement and assist it. Typically, CDS provide a qualitative and quantitative result from a set of input data regarding a patient. CDS Systems make use of data mining and knowledge discovery trained systems to quickly derive the answer from a well-formatted and standardised input.

The quality of CDS Systems lies on the training process. Extensive training requires relevant, significant and correctly classified sample data that is used in a computing intensive process to adjust the internal parameters of classifier engines that drive the classification. Depending on the input data and the extent of training, different accuracy is obtained. It is thus very important to provide tools for training the classifier engines and to provide a framework in which different engines can publish their accuracy and effectiveness. Using different engines world-wide as a whole, one can obtain a more contrasted and well-founded result.

Please consult the introduction slides for further details.

Dr kondekar santosh venketraman
child health specialist at HIS best!
9869803343
pediatrician; seth G S Medical colllege
KEM Hospital - Parel/Bhabha Hospital - Bandra
Mumbai

http://www.openclinical.org/e-Health.html

2006-02-18T04:45:00.000-08:00

http://www.openclinical.org/e-Health.html

Pediatrician's diary

2005-12-20T03:22:00.000-08:00

Child Health and Pediatric Medicine, Learning Center

childhood asthma in india need for modifying GINA guidelines for INDIA

national treatment guidelines for malaria

ring enhancing granulomas, vanishing CT scan lesions

tumors,oncogenes,syndromes

floppy infant syndrome

failure to thrive approach

FW: {Pediatric Doctors} Few formulas which might help doctors working in NICU

Yale Observation Scale

Pharyngitis

Mental retardation a video review

if you are looking for a page and it is not seen here, please check archives or site search. thank you.

CCF and shock in children

experience of tetanus cases from mumbai

malabsorption syndromes: a clinical approach in children

peditips

early postnatal care after birth

Tuberculosis in Children

inotropic support , dopamine , and other inotropes in children

Receptor pharmacology

This page is meant mainly for clinical tips.. pediatric medicine tips and tricks

Scarlet fever

anticoagulation in children

pediatric hypotension. Low blood pressure in children

methods of recording BP

Infants

Older children

for pediatricians : clinical tips

how to inject medicines to babies?

oral/RT rehydration is almost as efficacious as parenteral, provided the feeding is supervised despit vomitting and sepsis is ruled out.

Re: paediatrics yahoo case discussion: query

case discussion: query

tachycardia and tachypnea

http://egee-na4.ct.infn.it/biomed/CDSS.html

http://www.openclinical.org/e-Health.html

Pediatrician's diary