LIKE ON FB

Saturday, September 26, 2015

dengue fever protection and prevention Mumbai India when to worry?


As the flu started waning, dengue started rising... beware of mosquitoes.. the repellent creams have been the best for protection till date. Do take care even though the dengue cases this year are often not complicating... and surely dengue cases don't die of low platelets unless it causes some serious bleed.
apart from these... a new virus like say adenovirus appears to have visited town since a week or two.. causing kids and adults to lose voice after a day of high fever and body aches. Luckily its self limiting and may not need antibiotics too.Take care not to spread these viruses, do follow basic hygeinic measures of hand wash/hand shake/sneezing etc  read more

Recently Dengue fever cases are on rise with decline in malaria cases in Mumbai.

It can present in various different forms with different patterns of fever or no fever. The care in Dengue fever is like that in any viral fever as mentioned below but in addition dengue can at times gets serious and life threatening and early signs that may warrant extra care/ monitoring or hospitalisation are:
1. drop in platelet count or total cell count
2.swollen face or limbs/hands/feet or distended tummy all may suggest fluid retention
3. reduced urine, low blood pressure or giddiness or feeling for lying down in bed than sitting or doing normal work
4.any rash/bruses or bleeding or similar manifestation
Tests that may make a confirmation are NS1 antigen test fro first 3-4 days of fever , then IgM and IgG tests for Dengue in subsequent days.
Tests are less important than clinical monitoring.Real risk may start when fever disappears and platelets start falling down.
Many viruses cause similar picture and are called dengue like illness when tests are negative. once first weeks symptom phase is passed, relatively there little or no risk due to dengue. As it spreads by mosquito bite, a simple trick of using body creams of mosquito repellant like say odomos will help prevent mosquito bites and spread of dengue from person to person in family and kids.
dont waste money on fruits.. its a rumour. read more
Dr Kondekar

click here for basic care in viral fevers

Http://kondekar.weebly.com/.../care-in-viral-fevers-how...
REPLY





 IMA dengue guidelines and has asked citizens not to panic. The present serotype is less fatal than the one in 2013 and the more reliable test is haematocrit rather than test for platelet count. Here are a few important things about dengue that you should know:
1

New serotype of dengue

Dengue normally are of Den1, Den2, Den 3 and Den4 serotypes.

Serotypes 1 and 3 are less dangerous as compared to 2 and 4.

This year serotypes 2 and 4 are prevalent.

As per AIIMS, the type 4 strain of the disease has emerged as the dominant type for the first time in the capital, along with dengue type 2.
2.Serotype-specific symptoms

Symptoms of type 4 dengue include fever with shock and a drop in platelets.

Type 2 causes a severe drop in platelets, haemorrhagic fever, organ failure and dengue shock syndrome.

Every strain carries the risks of hemorrhagic fever, but type 4 is less virulent than type 2. Risk of severe dengue is highest with dengue-2 viruses.
3.General symptoms

Classic dengue fever is an acute febrile illness accompanied by headache, retro orbital pain, and marked muscle and joint pains.

Symptoms typically develop between four and seven days after the bite of an infected mosquito.

The incubation period may range from three to 14 days. Fever typically lasts for five to seven days.

The febrile period may also be followed by a period of marked fatigue that can last for days to weeks, especially in adults.

Joint pain, body aches, and rash are more common in females.

2 days after the last episode of the fever are crucial and during this period, a patient should be encouraged to take plenty of oral fluids mixed with salt and sugar.

The main complication is leakage of capillaries and collection of blood outside the blood channels leading to intravascular dehydration.

Giving fluids orally or by intravenous routes, if given at a proper time, can save fatal complications.
4.
Do not panic

Most dengue patients are not serious, dengue is both preventable and manageable.

The risk of complications is in less than 1 per cent of dengue cases and, if warning signals are known to the public, all deaths from dengue can be avoided.

A platelet transfusion is not needed unless patient has active bleeding (other than petechiae) and platelet counts are less than 10,000.

Unnecessary platelet transfusion can cause more harm than good.
5.'Warning signs': Only these need admission

Severe abdominal pain or tenderness.

Persistent vomiting, lethargy or restlessness.

Abrupt change from fever to hypothermia.

Bleeding, pallor.

Cold /clammy extremities.

Liver enlargement on physical exam.

Abnormal mental status.
6.
Early recognition

Dramatic plasma leakage often develops suddenly; therefore, substantial attention has been placed on early identification of patients at higher risk for shock and other complications.

The period of maximum risk for shock is between the third and seventh day of illness. This tends to coincide with resolution of fever. Plasma leakage generally first becomes evident between 24 hours before and 24 hours after defervescence.

An elevation of the hematocrit is an indication that plasma leakage has already occurred and that fluid repletion is urgently required.

Low platelet count usually precedes overt plasma leakage.

Mild elevations in serum SGOT and SGPT levels are common. Bit in severe dengue the levels are very high with SGOT > SGPT levels.

A normal SGOT levels is a strong negative predictor of severe dengue even in the first three days of illness.

NS 1 of >600 mg/ml suggests severe dengue.

Coexisting medical conditions and chronic hemolytic disease may complicate management. Referral for hospitalization is recommended for such patients, regardless of other findings.

Additionally, hospitalization should be considered for patients who may have difficulties with outpatient follow-up (eg, patients who live alone or who live far from a healthcare facility without a reliable means of transport).

Patients with suspected dengue who do not have any of the above indicators probably can be safely managed as outpatients. Daily outpatient visits may be needed to permit serial assessment of blood pressure, hematocrit , and platelet count.
7.Fluid requirement

20 ml/kg body weight as bolus

10 ml/kg over the next first hour

7 mL/kg/hour for next two hours

5 ml/kg/hour for next four hours

3 ml/kg/hour for next 8 hours
8.Assessment

Must pass urine every three hours.

Duration of extra fluids.

The fluids that are lost into potential spaces (eg, pleura, peritoneum) during the period of plasma leakage are rapidly reabsorbed.

Intravenous fluid supplementation should be discontinued once patients have passed the period of plasma leakage.

Usually no more than 48 hours of intravenous fluid therapy are required.

Excessive fluid administration after this point can precipitate hypervolemia and pulmonary edema.
9.When to discharge

In the absence of complications from prolonged hypotension or from medical interventions, most patients with severe dengue recover within a few days of admission.

No fever for at least 24 hours.

Two days have passed after an episode of shock.

Patient is clinically well.

Normal normal appetite, urine output, and hematocrit.
10.
No aspirin

Patients with dengue should be cautioned to maintain their fluid intake to avoid dehydration and to take paracetamol as needed for fevers and myalgias.

Aspirin or nonsteroidal antiinflammatory agents should generally be avoided.
11.
Some more facts

Doctors were expecting the strain to change this year, given the large number of cases. Doctors were not expecting type 4 because it has never been actively circulating in Delhi.

When the dominant strain remains the same for a long period, a significant population develops immunity to it, and fewer patients are diagnosed with the virus.

Infection with one of the four serotypes of dengue virus (primary infection) provides lifelong immunity to infection with a virus of the same serotype.

However, immunity to the other dengue serotypes is transient, and individuals can subsequently be infected with another dengue serotype (secondary infection).

Subsequent infection with a second type increases the likelihood of serious illness.

The risk for severe dengue appears to decline with n age, especially after age 11 years.
Forwarded message.

http://kondekar.weebly.com/blog-ask-comment/dengue-fevers-in-mumbai










































डॉं कोंडेकर संतोष वेंकटरमण@मुंबई Dr Santosh Kondekar is now also available at Shushrusha hospital Dadar West . Mumbai India. Monday to Friday at 7 to 9 PM. www.kondekar.com DR SK is a qualified pediatrician with MD and DNB qualification, from India who has specialised himself in counselling parents and children about the knowledge and various aspects of child health, illness, treament, diseases and their doctors. Dr SK is working as a pediatric intensivist and respiratory and infections specialist at Seth G S Medical College and KEM Hospital Mumbai India 400012. He has clinical expertise in guiding doctors, patients and also managing various illnesses and / or clinical situations concerning child health and its aspects like: Growth, Development Social and behavioural pediatrics including ADHD Respiratory illnesses including cold,cough, asthma Cardiac illnesses including congenital defects and rheumatic diseases Renal diseases Gastrointestinal diseases including diarrhea, vomiting, infections. hematological illnesses including anemias and hemorrhages. and various infections caused by various bugs like bacteria viruses and fungus. and many other clinical situations, illnesses, diseases. He has special interest in tuberculosis and other infections affecting various body organs and systems. The answers posted at above website are sole opinions of Dr SK with or without references and personal experience. These answers are just hypothetical and logical assesment of the limited information provided by the parent to the doctor in the form. The doctor being not able to examine the patiet and / or being not able to have access to reports, is practically not in a position to make diagnosis orprove it wrong... or suggest any treatment. Treatment suggested by this doctor at this site is just a hypothetical suggestion in agiven hypothetical limited situation which the parent may use for his basic understanding or discussion with his doctor, and for understanding and following basic health norms. Donot follow any prescription just because it was mentioned at this site. The consultation didnot take place, as the doctor has not examined the patient, legally its impossible to give any online prscription. What the doctor had written here is not a prescription for the given hypothetical case.
-->

Saturday, August 15, 2015

Why one needs a balanced diet for kids?

Kids have high demand for growth. Every body tissue needs calories for its growth. . That comes from sugars; fat for its metabolism and energy stores.. that comes fron oils.. aminoacids for tissue and dna building.. that comes from proteins.

A lots of micronutrients are required in small amounts for various body functions, enzymes, chemical reactions, metabolism, dna synthesis and neurological growth too.

Each body cell is like a small factory. . Whose heart is dna in the nucleus which is made up of aminoacids linked with sugar and phosphate bonds. .

Each cell has a kitchen called mitochondria which has energy store source where most metabolism occurs  and it along with golgi bodies intitiates productions of various special proteins and enzymes for body functions. All including cell wall needs regular nutrienta like water calories carbohydrates proteins and fat.
To make a cell survive, proper nutrition is needed. Faulty diet can make every cell deficient for the nutrient.
Thus balanced diet is need for cellular level nutrition which will be key to health.

Thursday, August 13, 2015

Why a mother of a two month old feel that her milk is not enough for her baby?

Its very common for a mother of two or three month old infant to feel that her milk is not enough because:
1.she feels so.. due to her perception of baby size or compared to peers
2.other family members or friends feel so
3. Baby appears thin.
4. Baby cries often
5. Baby leaves breast in few minutes
6. Mother feels she has less out put
7. She feels her breast size is small or not enough

All these reasons are incorrect.. if mother milk is not enough, the baby will start losing weight. Now why these assumptions are incorrect? Dont hesitate to ask here.
Www.kondekar.com

Friday, June 19, 2015

Vomiting in children

Vomiting:... a often true symptom but wrongly labelled or wrongly interpreted by people makes doctors mismanage at times.
Anything that looks like vomiting need not be vomiting.
Something coming out of mouth.. say curdish milk in infants is called possetting... a normal phenomena.
If its frothy or spitting out.. beware it may be type of seizure if child is losing eye contact along with.
The term vomiting from inside often means retching reflux or at times throat discomfort....
Vomiting just before cough and immediately with food is often choking or gagging than vomiting as seen th throat or tonsil issues.
Vomiting little time after food can be food pipe or gut problems primarily infections.
Vomiting with infection doesnt last more than three days.
Vomiting with hyperacidity or neurological issues tend to recur unless properly treated.
Repeated vomits can also be due to hut obstruction or TB.
Vomiting lasting for weeks surely has a serious problems. also available at kondekar.com
Sometimes it can be psychogenic especially in some adolescents.
In viral gastroenteritis its often with loose stools. In dysentery; vomiting are uncommon.

Vomiting that doesn't cause weight loss or is barely 2-3 times a day may not be serious unless known cause in background.
Vomiting with jaundice or yellow urine is likely to be waterborn hepatitis.
Vomiting after medicines and stale food is pretty common and most vomitings need chewable antiemetics with fluid support till the disease is understood. For details whatsap 9869405747


from www.facebook.com/ChildSpecialistmumbai




डॉं कोंडेकर संतोष वेंकटरमण@मुंबई Dr Santosh Kondekar is now also available at Shushrusha hospital Dadar West . Mumbai India. Monday to Friday at 7 to 9 PM. www.kondekar.com DR SK is a qualified pediatrician with MD and DNB qualification, from India who has specialised himself in counselling parents and children about the knowledge and various aspects of child health, illness, treament, diseases and their doctors. Dr SK is working as a pediatric intensivist and respiratory and infections specialist at Seth G S Medical College and KEM Hospital Mumbai India 400012. He has clinical expertise in guiding doctors, patients and also managing various illnesses and / or clinical situations concerning child health and its aspects like: Growth, Development Social and behavioural pediatrics including ADHD Respiratory illnesses including cold,cough, asthma Cardiac illnesses including congenital defects and rheumatic diseases Renal diseases Gastrointestinal diseases including diarrhea, vomiting, infections. hematological illnesses including anemias and hemorrhages. and various infections caused by various bugs like bacteria viruses and fungus. and many other clinical situations, illnesses, diseases. He has special interest in tuberculosis and other infections affecting various body organs and systems. The answers posted at above website are sole opinions of Dr SK with or without references and personal experience. These answers are just hypothetical and logical assesment of the limited information provided by the parent to the doctor in the form. The doctor being not able to examine the patiet and / or being not able to have access to reports, is practically not in a position to make diagnosis orprove it wrong... or suggest any treatment. Treatment suggested by this doctor at this site is just a hypothetical suggestion in agiven hypothetical limited situation which the parent may use for his basic understanding or discussion with his doctor, and for understanding and following basic health norms. Donot follow any prescription just because it was mentioned at this site. The consultation didnot take place, as the doctor has not examined the patient, legally its impossible to give any online prscription. What the doctor had written here is not a prescription for the given hypothetical case.
-->

Sunday, May 24, 2015

Does your child make funny throat sounds? Docs call ita postnasal drip!@

Do you or your kid makes funny sounds from throat?
Funny sound behind nose or in throat like clucking chukcling vibrating or just like sounds of machines like say scooter... oops... any such sounds including those that look like repeated clearing of throat and like something stuck at or itching at palate throat or tongue..

All Have A Reason!@
These sounds need not be associated with breath in or out... if they are then we may call it like stridor. If not, we call it PND or post nasal drip irritation making u clear the throat in funny way.

Solution: get checked by your doctor if you have allergy or allergic rhinitis... or get treated for it.
Gargling helps.. so do antihistamines  syrups tablets n sprays for temporary relief.  Your dr may start special medicines depending on level of symptom frequency.
Symptoms that are more so in early morning... are more likely related to allergic rhinitis. Read rule of S at www.breathingdiary.com

Saturday, May 23, 2015

Understand your child health issues and doctor

Text dr kondekar on whatsapp or telegram 9869405747 INDIA.. Get online advice.

Read disclaimer at www.kondekar.weebly.com also read what to ask a doctor and what not to ask a doctor in health visit at the website.

Tuesday, May 5, 2015

World Asthma Day 2015

 WORLD ASTHMA WEEK 2015
Paediatricians and chest specialists all over world will be celebrating world asthma day/week today at many hospitals. The theme is 'YOU CAN CONTROL YOUR ASTHMA'..0 its time to act.

In my experience, I feel that the name ASTHMA has always been taken with taboo by many people and doctors, so much so that people have developed myths that..'its incurable..' or 'its a lifelong disease needing life long treatment' 'medicines cause addiction' or once an inhaler always an inhalers'.. These myths are false; but due to this, many children and adults are taken to various different doctor and non doctor specialists; that keeps the patient incompletely cured and hence uncontrolled.
its time to control asthma. the very first way is to  @know that what the child or person is suffering from is an asthma for sure@
This is very important. If its not asthma; how will it get controlled?
The rule of asthma diagnosis needs to be clearly understood that 'ASTHMA IS DIAGNOSIS BY EXCLUSION' and when we donot follow this; we donot get to other diagnoses and get mismanaged.

So when you are not happy with treatment of your asthma; its wiser to insist to your doctor to consider nonasthma diagnoses causing similar symptoms seriously. read more in OTA section at www.breathingdiary.com

Once we are certain, it is asthma; the control of asthma can easily be handed over in hands of parents provided:
1. patient/parent have understood the symptoms, disease profile, symptom prediction by peak flow metry and charting and need for charting the symptom diary. Simplest yet best symptom diary for asthma at www.breathingdiary.com
2.patient / parent can easily be trained into classification of symptoms and rescue medicine concept by simple training. All patients donot need inhalers or steroids all the time. Remember rule of S at www.breathingdiary.com, that dictates the need for steroids.
3. Also, parents should understand the need for 'duration', 'step up-down therapy' and tapering therapy and also the need for allergen detection and avoidance when possible will help the patient be symptom free almost all the time.
4.An early eye on detecting associated morbidities and allergies; milk free diet and simultaneous treatment of any morbidity if any will prevent further symptom exacerbations.
If the education is effectively imparted to the parents/patient and family, schools and community; the reactive airway disease will remain controlled and cured in most cases; instead of remaining a scare with its name as ASTHMA.
- www.kondekar.com











=========================================================================
@मुंबई Dr Santosh Kondekar is now also available at Shushrusha hospital Dadar West . Mumbai India. Monday to Friday at 7 to 9 PM. www.kondekar.com DR SK is a qualified pediatrician with MD and DNB qualification, from India who has specialised himself in counselling parents and children about the knowledge and various aspects of child health, illness, treament, diseases and their doctors. Dr SK was working as a pediatric intensivist and respiratory and infections specialist at Seth G S Medical College and KEM Hospital Mumbai India 400012 till 2010. He has clinical expertise in guiding doctors, patients and also managing various illnesses and / or clinical situations concerning child health and its aspects like: Growth, Development Social and behavioural pediatrics including ADHD Respiratory illnesses including cold,cough, asthma Cardiac illnesses including congenital defects and rheumatic diseases Renal diseases Gastrointestinal diseases including diarrhea, vomiting, infections. hematological illnesses including anemias and hemorrhages. and various infections caused by various bugs like bacteria viruses and fungus. and many other clinical situations, illnesses, diseases. He has special interest in tuberculosis and other infections affecting various body organs and systems. The answers posted at above website are sole opinions of Dr SK with or without references and personal experience. These answers are just hypothetical and logical assessment of the limited information provided by the parent to the doctor in the form. The doctor being not able to examine the patiet and / or being not able to have access to reports, is practically not in a position to make diagnosis orprove it wrong... or suggest any treatment. Treatment suggested by this doctor at this site is just a hypothetical suggestion in agiven hypothetical limited situation which the parent may use for his basic understanding or discussion with his doctor, and for understanding and following basic health norms. Donot follow any prescription just because it was mentioned at this site. The consultation didnot take place, as the doctor has not examined the patient, legally its impossible to give any online prescription. What the doctor had written here is not a prescription for the given hypothetical case.
-->

Tuesday, December 9, 2014

child infant skin rash, is it allergy ot chiken pox or handfoot mouth disease or measles

                                                              Skin rash with fever in kids. Getting rational!@



www.kondekar.comAllergy does cause an itchy swollen rash... often without fever and at times may progress to respiratory discomfort.. and hence need to be promptly understood treated and prevented. Common allergies are related to diet protein nut/egg/oats/milk/fish etc
Around winter.. three types of viral rashes are often seen. Although any viral fever including dengue fever can rash; the viral rash is often strongly described and seen with measles and chicken pox and hand foot mouth disease.
Commonest of these 3 being hand foot mouth disease HFMD... is the mildest of all and often may not need any specific measures unless has bad oral sores or complications. Its easy to know that HFMD rash is small reddish mini fluid bumps and doesnt affect trunk or back and often has a mouth sore. Fever may be short and mild. All may disappear in two weeks though can spread very fast.
Chicken pox on other hand appears more dreadful and scary rash. It has high fever at onset with trunk lesions and takes three days to spread over rest of body. Different sizes and stages of small to large fluid bumps called vesicles in different stages at a time and each bump surely scarring in a week; and no new bumps beyond ten days since onset is most likely chicken pox. It can cause complications like acute pneumonia.
Rash of HFMD is discrete-small and in measles bumps are very small size and in 'chicken pox and measles' heavily spread all over body.
Measles rash is more common in kids who have skipped measles vaccine of 10 month age. Rash is fine sand like but red; starting in neck with high fever and spreading all over body in two days. Fever settles by three days and rash in a week without any scar. If u see WOUNDS or scar.. surely its not measles. Measles causes fall in immunity and has serious complications like pneumonia or TB to follow over a month.

Its important not to panic; but understand the disease course and visit a doctor earliest. Read danger signs and basic care in viral fever at kondekar.com

Remember if child refuses feed even twice or prefers to lie down more than six hours without sleep.. it may be a sign for hospital based observation.
There are tens of viruses and bacteria that cause a large variety of rashes. This is just an awareness basic.


from www.facebook.com/ChildSpecialistMumbai


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

डॉं कोंडेकर संतोष वेंकटरमण@मुंबई Dr Santosh Kondekar is now also available at Shushrusha hospital Dadar West . Mumbai India. Monday to Friday at 7 to 9 PM. www.kondekar.com DR SK is a qualified pediatrician with MD and DNB qualification, from India who has specialised himself in counselling parents and children about the knowledge and various aspects of child health, illness, treament, diseases and their doctors. Dr SK is working as a pediatric intensivist and respiratory and infections specialist at Seth G S Medical College and KEM Hospital Mumbai India 400012. He has clinical expertise in guiding doctors, patients and also managing various illnesses and / or clinical situations concerning child health and its aspects like: Growth, Development Social and behavioural pediatrics including ADHD Respiratory illnesses including cold,cough, asthma Cardiac illnesses including congenital defects and rheumatic diseases Renal diseases Gastrointestinal diseases including diarrhea, vomiting, infections. hematological illnesses including anemias and hemorrhages. and various infections caused by various bugs like bacteria viruses and fungus. and many other clinical situations, illnesses, diseases. He has special interest in tuberculosis and other infections affecting various body organs and systems. The answers posted at above website are sole opinions of Dr SK with or without references and personal experience. These answers are just hypothetical and logical assesment of the limited information provided by the parent to the doctor in the form. The doctor being not able to examine the patiet and / or being not able to have access to reports, is practically not in a position to make diagnosis orprove it wrong... or suggest any treatment. Treatment suggested by this doctor at this site is just a hypothetical suggestion in agiven hypothetical limited situation which the parent may use for his basic understanding or discussion with his doctor, and for understanding and following basic health norms. Donot follow any prescription just because it was mentioned at this site. The consultation didnot take place, as the doctor has not examined the patient, legally its impossible to give any online prscription. What the doctor had written here is not a prescription for the given hypothetical case.
-->

Sunday, July 7, 2013

Fever Cough, cold, Flu? is it flu? will it need antibiotics?

Fever Cough, cold, Flu? is it flu? will it need antibiotics?
Viral fevers of respiratory system are called flu. Flu is something that comes with nose throat symptoms and fever may be optional. if it gets to chest, there is danger of pneumonias and also serious issues.
In typical viral flu, fever may be there for a day or two at beginning and later runny nose or stuffy nose for two days... as nose starts settling cough pics up and may last for a week. Child intake gets reduced adding another danger.
Often A dr will add a fever treating medicine in beginning with an antihistaminic combination for few days and as cough starts the medicines may be switched over  to cough syrups; which may be sedatives and if there is more night cough bronchodilator cough syrups may be needed.
Antibiotics may become essential if Dr thinks about a bacterial disease or complication.
Key to adequate response to therapy is a detailed history, close watch on danger symptoms, Doctor's clinical acumen on picking up signs , deciding appropriate therapy based on current flu strains in community added the experience. Doses matter a lot in kids and cough syrups come with caution of life threatening dangers. Doses of drugs and compliance of patient decidesthe response. click for ask/details. As there are different bacteria, differeent antibiotics likely depending on clinical impressiob by your doc.
Please visit a doctor.

What is nebulisation?
its a form of cold mist with or without medicines used to sooth the airways by inhalation through nose and mouth, Nothing scary or addictive. If the child cries, may be better will be the effect.
advantage small doses, less system side effects than medicines taken by mouth. May help. Discuss with your doctor..


डॉं कोंडेकर संतोष वेंकटरमण@मुंबई Dr Santosh Kondekar is now also available at Shushrusha hospital Dadar West . Mumbai India. Monday to Friday at 7 to 9 PM. www.kondekar.com DR SK is a qualified pediatrician with MD and DNB qualification, from India who has specialised himself in counselling parents and children about the knowledge and various aspects of child health, illness, treament, diseases and their doctors. Dr SK is working as a pediatric intensivist and respiratory and infections specialist at Seth G S Medical College and KEM Hospital Mumbai India 400012. He has clinical expertise in guiding doctors, patients and also managing various illnesses and / or clinical situations concerning child health and its aspects like: Growth, Development Social and behavioural pediatrics including ADHD Respiratory illnesses including cold,cough, asthma Cardiac illnesses including congenital defects and rheumatic diseases Renal diseases Gastrointestinal diseases including diarrhea, vomiting, infections. hematological illnesses including anemias and hemorrhages. and various infections caused by various bugs like bacteria viruses and fungus. and many other clinical situations, illnesses, diseases. He has special interest in tuberculosis and other infections affecting various body organs and systems. The answers posted at above website are sole opinions of Dr SK with or without references and personal experience. These answers are just hypothetical and logical assesment of the limited information provided by the parent to the doctor in the form. The doctor being not able to examine the patiet and / or being not able to have access to reports, is practically not in a position to make diagnosis orprove it wrong... or suggest any treatment. Treatment suggested by this doctor at this site is just a hypothetical suggestion in agiven hypothetical limited situation which the parent may use for his basic understanding or discussion with his doctor, and for understanding and following basic health norms. Donot follow any prescription just because it was mentioned at this site. The consultation didnot take place, as the doctor has not examined the patient, legally its impossible to give any online prscription. What the doctor had written here is not a prescription for the given hypothetical case. -->

Tuesday, April 16, 2013

tonsil adenoids in children, is it asthma or infection?


What are tonsils and adenoids?
They are the protective pillars at the entry point of infection that is throat and nose respectively. Dominant in children below 5 years age as they are weak, By age 10 yr age, most children have very small tonsils and adenoids and practically not serving any purpose.

What age children get affected? adults?
Usual age is 2 to 7 years. Those kids who have chronic symptoms may have it persistent in adults.

How do tonsils and adenoids get infected?
As they are the first pass gaurds, any infection entering from food or breath/aerosol can affect them respectively.

Is it infection or allergy?
Not allergy for sure. tonsils infections are easy to confuse with asthma while adenoid infections are easy to confuse with allergic rhinitis. As symptoms are overlapping to large extent.

How does a doctor make out a child having tonsils and adenoids?
from their symptom profile. In case of adenoids, the kids have nose block on throat side.. and kids often present with runny nose lasting 2 weeks or more.As the nose is almost blocked , these kids may have mouth breathing. fever, growth failure and reduced diet can be off and on. often there is bad breath, snoring and speech issues. rising pressure in ears may also cause ear pain and discharge as adenoids are close to ear openings in throat.
Tonsils often present with fever throat pain or fever cough or fever vomiting episodes. Often get cured with symptomatic therapy. there may be bad breath, hot potato speech or reduced solid intake. Children often look thin short and active. there are often nodes seen just around angle of jaw. Tonsils and house of tonsils often looks inflammed red in acute infections and may get sticky to uvula or other tonsils.
Reduced diet and growth failure is very common and may necessitate surgery.

Any investigations needed?
Adenoid examination by IDL test, Xray nasopharynx (digital) often shows adenoids blocking nose from throat side. Often it may block Eustachian tube.. the openings of ear inside throat.
For tonsils, a throat examination is enough. A blood count or strept test for throat may decide the course of antiniotic therapy.... but if there is any suspicion of TB, one may need node biopsy.

Does it cause growth failure?
As both these cases cause reduced intake, and frequent symptoms poor weight and eventually porr height gain is not uncommon.

Do all kids need surgery for tonsils?
No, unless growth failure or 7-8 episodes in a year affecting quality of life.

Does it cause bad breath, disfigurement of face or teeth?
possible.

Is it due to bottle feeding?
possible

Does it cause leaky ear or ear infection?
possible.

Is there any permanent cure?
yes.. surgery but not needed in all cases. Even natural cure at times.

Are there any medicines?
yes. often symptomatic. Intermittent antibiotic courses and decongestants.

When and how to take these medicines?
Please visit a doctor for prescription.

Is this viral?
possible, but not all cases are viral.

Is this asthma?
It can cause asthma like symptoms so much so that sometimes these cases do need asthma like medicines,

Why do some children worsen?
due to neglect... due to large tonsils, frequent symptoms, inadequate therapy, and in some cases parents refusal to give antibiotics despite need.


And many more questions on tonsil adenoid infections,answers will soon be posted at www.kondekar.com
If you have any query regarding tonsil or adenoid issues about your child, do write back at www.kondekar.com





















डॉं कोंडेकर संतोष वेंकटरमण@मुंबई Dr Santosh Kondekar is now also available at Shushrusha hospital Dadar West . Mumbai India. Monday to Friday at 7 to 9 PM. www.kondekar.com DR SK is a qualified pediatrician with MD and DNB qualification, from India who has specialised himself in counselling parents and children about the knowledge and various aspects of child health, illness, treament, diseases and their doctors. Dr SK is working as a pediatric intensivist and respiratory and infections specialist at Seth G S Medical College and KEM Hospital Mumbai India 400012. He has clinical expertise in guiding doctors, patients and also managing various illnesses and / or clinical situations concerning child health and its aspects like: Growth, Development Social and behavioural pediatrics including ADHD Respiratory illnesses including cold,cough, asthma Cardiac illnesses including congenital defects and rheumatic diseases Renal diseases Gastrointestinal diseases including diarrhea, vomiting, infections. hematological illnesses including anemias and hemorrhages. and various infections caused by various bugs like bacteria viruses and fungus. and many other clinical situations, illnesses, diseases. He has special interest in tuberculosis and other infections affecting various body organs and systems. The answers posted at above website are sole opinions of Dr SK with or without references and personal experience. These answers are just hypothetical and logical assesment of the limited information provided by the parent to the doctor in the form. The doctor being not able to examine the patiet and / or being not able to have access to reports, is practically not in a position to make diagnosis orprove it wrong... or suggest any treatment. Treatment suggested by this doctor at this site is just a hypothetical suggestion in agiven hypothetical limited situation which the parent may use for his basic understanding or discussion with his doctor, and for understanding and following basic health norms. Donot follow any prescription just because it was mentioned at this site. The consultation didnot take place, as the doctor has not examined the patient, legally its impossible to give any online prscription. What the doctor had written here is not a prescription for the given hypothetical case. -->

Tuesday, December 11, 2012

Loose motions "acute gastroenteritis" dehydration dysentery

For COUGH related queries, please read my article  
for clinic address in Mumbai, India please visit www.doctorchild.com

Acute DIARRHEAS... WATER LOSS.. DEHYDRATION... DYSENTERY,., QUERIES

All diarrheas are not same…
They are caused by infections and many times without infections.
Causes of diarrhea are different at different ages too.
Apart from causes-- pattern of diarrhea is also important. Some are watery and some with less water. Some are sticky and some with blood. Some do have serious reason under it. Some do cause serious complications.
in summary a common medicine or formula can not be applied to a case of diarrhea without knowing above details.
Often there is a confusion that teething causes diarrhea, winter causes diarrhea.. monsoon causes diarrhea...etc there is scientific logic which needs to modify these beliefs.
Teething Diarrhea
Often parents come with various tonics for dentition available in market...practically teething per say does not cause diarrhea. during teething the important milestone of hand to mouth and biting starts developing. at this phase kids even start chewing clothes, fingers and toys. the germs that get carried along with this; often end up causing gut or throat infections. Both may cause diarrhea.. simple hygeinic measures and controlling cloth/toy chewing may settle this. If there is serious pica associated may need an attention.
Cold/ cough related diarrhea
in nose, throat, ear infections the mucus secretions or pus gets swallowed in small infants and passes through gut undigested and may look like mucus in stools.. but may smell same as nose secretions.
monsoon diarrhea
Often this is due to water/ feed or hand contamination. Though usually rotavirus related in first year of life; there are many other viruses and bacteria that may cause such monsoon diarrheas. bacterial diarrheas and dysenteries predominate in summer and in areas and seasons of water scarcity too. Often such diarrheas are more watery compared to dyentry.
watery diarrheas
diarrhea is often watery. how much water content per stool may decide the level of infection. Infections from small inetstine often cause large watery diarrheas (enteritis). As the infection spreads from small to large intestine; the water content gets lesser and pain or cramps .. and mucus/blood may come in stools.(enterocolitis).when this happens.. the diarrhea is no longer just diarrhea, but is called dysentery. All diarrheas may not go through this phase. There are some viruses that causes redominant gastritis.. some do cause gastroenteritis; some cause only enteritis and some cause entrocolitis; while soem cause colitis.
dysentery
whenever water content of stool is not enough to make the bed "wet", lets call these diarrheas as nonwatery or may be dysentry. dysentery is presence of mucus or blood in stool/poop. dysentery may be associated with spurts of water.. which is often due to inflammation of rectum ( proctocolitis).
Dysentery may be due to amebiasis, bacteria or antibiotic induced.
Viruses often do not cause dysentery.

Commonest cause of loose stools in developing countries liek India are giardiasis (a form of protozoa); and in elderly kids may eb amebiasis.
Commonest cause of watery diarrheas.. in infants in rotavirus related, in seasons. otherwise can be toxin producing e coli bacteria or salmonella bacteria.. Cholera is a serious cause of severe watery diarrhea... and needs specific therapy. In cholera 1 or 2 motions can make a child very sick. The stool has fishy smell and looks like rice water.
Common causes of diarrhea without too much of water loss, are non rotavirus viruses and bacteria..Most bacteria produce a toxin or they may also attack the intestinal skin (epithelium) and may cause infection, bleed or holes in mucosa that may take days to heal.
each bacterial diarrhea my not need antibiotic too, but most need it.
When to stop breast milk in diarrheas ?
Breast milk is best and should not be stopped in diarrheas. feeding is essential component in maintaining feeds and tackling dehydrations.In soem cases, when diarrhea lasts for longer than 4-5 days, the gut epithelium loses its factors required to digest lactose, a domonant sugar in milk. When lactose not digested, it carries water with it in stools and may harm and motions persist. In such cases breast milk or any milk that contains lactose should be promptly stopped for a week and the same phase should be replaced by lactose free formula or feeds for the same duration. Doctor diagnose this condition by looking at stool Ph and reducing substances in stools.

danger signs in diarrhea: any of  these signs if there may  risk life by dehydration or sepsis..they are as below:
1.reducing urine frequency and quantity
2.sleepy child, lethargic
3.child refusing feeds, voomiting not getting controlled
4.cranky or irrtable child , very thirsty child.. but fails to drink or digest
5.perianal rash..nappy rash, diaper rash or skin sores ulcers or redness.. easy to secondarily infected to complicate matters
6.fever not settling despite 72 hours

If any of these danger signs.. prefer the doctor sees the child very often or the child remains under hospital supervision and therapy. Parents cannot feel or assess the severity of diarrhea related issues which child may be going through. A child of 10 kg often needs 1 litre liquid daily to maintain circulation.A motion of hundred ml will compromise it by 10 % aqnd a 5 motions can compromise it by 50%.
be liberal with fluids with children suffering from gastroenteritis.

Leave the judgement of medicines to doctors.. as all diarrheas are not same in presentation, severity and treatment response. Commonly a diarrhea starts responding to medicines in 72 hours.. but may last 7 to 10 days.
डॉ कोंडेकर संतोष ,एम .डी,.डी.एन .बी.,डी.सी.एच.,एफ.सी.पी.एस.
विशेष बाल रोग निदान व उपचार केंद्र, ओपिडी नं ११
सायं ७ ते ९, सोम ते शुक्र ; शुश्रुषा हॉस्पिटल 
appt: 9869405747 रानडे रोड दादर (प). मुंबई ४०००२८

 post your free queries at www.kondekar.com 
Part II: managing diarrheas.. awaited..
डॉ कोंडेकर संतोष ,एम .डी,.डी.एन .बी.,डी.सी.एच.,एफ.सी.पी.एस.
सहप्राध्यापक बालरोग विभाग , बाल दमा विभाग 
टोपीवाला राष्ट्रीय वैद्यकीय महाविद्यालय 
बा.य ल नायर धर्मार्थ रुग्णालय मुंबई सेन्ट्रल 

child specialist on call..

DR SK is a qualified pediatrician with MD and DNB qualification, from India who has specialised himself in counselling parents and children about the knowledge and various aspects of child health, illness, treament, diseases and their doctors. Dr SK is working as a pediatric intensivist and respiratory and infections specialist at Seth G S Medical College and KEM Hospital Mumbai India 400012. 
He has clinical expertise in guiding doctors, patients and also managing various illnesses and / or clinical situations concerning child health and its aspects like: Growth, Development Social and behavioural pediatrics including ADHD Respiratory illnesses including cold,cough, asthma Cardiac illnesses including congenital defects and rheumatic diseases Renal diseases Gastrointestinal diseases including diarrhea, vomiting, infections. hematological illnesses including anemias and hemorrhages. and various infections caused by various bugs like bacteria viruses and fungus. and many other clinical situations, illnesses, diseases. He has special interest in tuberculosis and other infections affecting various body organs and systems. 

The answers posted at above website are sole opinions of Dr SK with or without references and personal experience. These answers are just hypothetical and logical assesment of the limited information provided by the parent to the doctor in the form. 
The doctor being not able to examine the patiet and / or being not able to have access to reports, is practically not in a position to make diagnosis orprove it wrong... or suggest any treatment. Treatment suggested by this doctor at this site is just a hypothetical suggestion in agiven hypothetical limited situation which the parent may use for his basic understanding or discussion with his doctor, and for understanding and following basic health norms.
 Donot follow any prescription just because it was mentioned at this site. The consultation didnot take place, as the doctor has not examined the patient, legally its impossible to give any online prscription. What the doctor had written here is not a prescription for the given hypothetical case.



Thursday, February 2, 2012

WHAT IS EPILEPSY?

Child health specialist pediatrician Mumbai presents epilepsy FAQs:
Following is not a medical prescription, but just for information. No medicines should be taken or changed without direct clinical consultation and prescription issued by your doctor.
.paid queries at this site click here 
Visit My Message Board for public or open queries.Fill the form at this site for private queries.

WHAT IS EPILEPSY?
A repetitive seizure disorder due to abnormal cortical excitation, manifesting as local or generalized paroxysmal stereotypical movements with or without loss of consciousness, with or without frothing at mouth, with or without passage of urine and stools , with or without visible, tonic/clonic manifestations of a seizure.

WHAT IS NOT EPILEPSY?
Single seizure with normal EEG is not an epilepsy. Movement disorders like tremors, chorea may be confused as epilepsy. Epilepsy may mimick syncope, migraine or vertigo

. WHAT ARE THE DIFFERENT PATTERNS OF EPILEPSY?
Epilepsy can be presenting as focal or generalized seizures without any aetiology as idiopathic epilepsy. When some reason is there, it may be called as pathological or syndromic epilepsy. Clinical patterns may vary from just twitching to tonic clonic movements and from syncope like events to unconsciousness.

HOW DO WE DIAGNOSE THEM
Diagnosis is often clinical. Investigations help in understanding prognosis and aetiology. EEG and MRI brain is often asked for in most epileptics.


DO’S AND DONTS WHEN A PATIENT GETS A SEIZURE
When a patient gets a seizure, let the seizure pass, turn the patient on one side to prevent aspiration of secretions. If available you may give oxygen and nasal midazolam or injectable or per rectal diazepam. Even if seizure is settled, giving medicine will delay next seizure. Discourage the myths about pouring water and applying strong smells or onion to nose , as it will harm the patient.

WHAT ARE THE EMERGENCY DRUGS FOR SEIZURE CONTROL?
Emergency seizure control can be achieved by any of the following drugs depending on availability: Intranasal midazolam spray, per rectal diazepam, intramuscular diazepam,intravenous diazepam or lorazepam or phenytoin or phenobarbitone. These drugs may have life threatening side effects if proper precautions not taken by the doctor.

WHATS ANTICONVULSTANTS TO BE USED FOR WHAT TYPE OF SEIZURES?
This is better left to the experts as type and pattern of seizure and availability of drugs and knowledge of dosages and side effects does matter.The drugs used in past for generalized and focal epilepsies in past that is phenobarbitone and phenytoin respectively, may not be recommendable in view of their side effects, as better drugs are available. Focal and temporal lobe seizures, complex partial seizures, respond better with carbamazepine and oxycarbazepine. Most generalized seizures are well controlled with valproic acid which is a relatively safe drug as the dosages with it can be easily titrated to double without side effects.Newer anticonvulsants shouldnot be used without specialists consultations.

WHAT ARE THE DOSAGES OF SEIZURE CONTROLLING MEDICINES?
Most common drugs like phenytoin, phenobarbitone have narrow therapeutic window and are used in dosages of 5mg/kg body weight per day. Valproic acid having a wider therapeutic window is used in doses of 15 to 40 mg/kg/day. Carbamazepine is used in doses of 10-20mg/kg/day. Should always be started by and confirmed with treating doctor.

HOW LONG THE SEIZURE THERAPY SHOULD BE CONTINUED?
Single seizures with normal EEG and also febrile seizures, often do not need long term seizure therapy. Once started for valid reasons, seizure therapy is usually continued to observe at least 2 years seizure free. Then afterwards there may be a chance of tapering and stopping the therapy, though not in all patients.

WHAT ARE THE SIDE EFFECTS OF SEIZURE THERAPY?
They differ with different drugs, from intellectual dysfunction to anemia, rickets, gynecomastia , obesity etc. Overdoses may cause sleepiness, ataxia, diplopia, headaches and convulsions with different drugs.

WHEN WILL IT GET CURED?
Once the patient is seizure free fro more than 2 years, and there is no other reason to continue the same medicines and on with drawl of medicines if seizures donot recur in 6 months, the disease may be taken as cured for that time.

CAN THE PATIENT SWIM OR DRIVE?
Should preferably be avoided till medicines are on, though many countries promote these activities once 2 years seizure free.

IS THERE ANY SURGERY?
Selective refractory cases with focal manifestations on clinical evaluation or EEG or MRI may be subjected to surgery.


CAN THEY GO TO SCHOOL?
Schooling and office work can be permitted as long as it is stress free and doesn’t involve being on empty stomach for longer hours.

ARE ALL OF THESE ARE MENTALLY RETARDED?
Some seizure patients have mental retardation as comorbidity or may be associated with developmental delay, more so in pediatric patients say of birth asphyxia. In fact, some of the epileptics are superintellectuals.




following is an advertisement!

Friday, October 14, 2011

recurrent cough and cold, are you worried of asthma or allergy?

ask Child health specialist pediatrician Mumbai....
what is cough, cold and wheeze?
Many parents and people have wierd ideas about cough, cold and wheeze.These interpretation are based on their knowledge, info, myths and perceptions. its better to be clean on these terms when we proceed to discuss further.

Cough: is an explosive sound when air comes out of mouth with a force. noises from nose, chest, throat during breathing is not cough. "Kaff" (in ayurveda) means a lot different than the word "cough". Cough is of different types and varieties, that may help a doctor assess its severity and origin and accordingly plan a therapy.

Cold: Ice is cold, when fever settles hands and feet may go cold. so cold is a very common word used for many issues. When meeting a doctor regarding respiratory issues, we will consider cold as "common cold". The word "common Cold" is used for symptoms of nose and throat with or without fever. Literally its  synonymous with flu.But describing this doesnt help a doctor much to understand the problem. So for all practical purposes we will call cold as runny nose/running nose/stuffy nose/sneezing/watering nose etc. Describing specifically will help doctor plan a specific therapy. cold often may be followed by cough and may be associated with noisy breathing and at times mouth breathing. Read  and understand each word carefully.

Wheezing: its a musical like sound, little longer and high pitch (softer), may be felt by hand on chest or heard aloud at times with child visibly distressed. It is different from noisy breathing which is mainly a sound like snorring or stridor which is louder, and low pitch. Doctor's precision may be needed to separate them. often wheeze is a late sign in asthma , though it has many reasons not related to asthma.

Recurrent cough/ cold/wheeze?
Many parents often feel that their child gets repeated cough cold wheeze etc. Often this may be biased if both parents are working. For example if a child coughs every night and if the parent comes home only at night, while informing the doctor parent may tell he is coughing all the time. This may affect diagnosis and therapy in a great way. Children below 3 year age in India and developing countries, get exposed to a number of respiratory viruses and pollution too. its normal for a child to have 4-8 episodes/year of respiratory issues in infants upto 2 years age. If it is more than 8 per year in first 2 years or more than 3 per year after 2 year age, its likely that this will be called "recurrent".
Recurrent doesnt always mean serious. Serious ones are those that last longer than 7 days, recurr within a gap of 2 weeks and may be life threatening ( see danger symptoms) and may affect weight gain and growth. Serious respiratory symptoms when recurrent (3 per year at any age) may need to be evaluated for associated congenital heart defects.

All these symptoms may be individual or together, with or without fever. Infections often come with fever, allergy / asthma like diseases often come without fever. Occasionally there may be overlap.Allergy / Asthma is difficult to define below 2 years age, its difficult to prove till 6 years age.
Therapy in both groups is primarily symptomatic.Fever medicines for fever, decongestants for runny nose, bronchodilators for wheezers, cough syrups (bronchodilator or suppressive) for cough.
Evaluations / investigations are supportive. Infections may need antibiotics at times, while Allergy / Asthma may need steroids at times.
lets discuss one by one in details. Treatment of runny nose is already discusssed.





 part 2... continued .. please await next posting or put a query in the form on top if you want further details in advance.for free.

WRITE A REVIEW ABOUT THIS SITE.

following is an advertisement!