Spotters in Pediatrics Anoop Verma, Sanjay Sharma, Ramesh Bhatt, Pulak Parag
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1Spotters in Pediatrics
2Spotters in Pediatrics
Editor-in-Chief Anoop Verma MD FIAP FIAMS Swapnil Nursing Home and Research Center Civil Lines Raipur, CG 492001 Chapter Editors Neurology Sanjay Sharma DM (PGI Chandigarh) Consultant Neurologist Modern Medical Institute, Lalpur, Raipur, CG Neonatology Ramesh Bhatt MD Associate Professor Dept. of Pediatrics, KMC, Manipal Pediatric Surgery Pulak Parag MS MCh (CMC Vellore) Pediatric Surgeon Consultant Pediatric Surgeon, Raipur, CG Navneet Jain MS Laparoscopy Surgeon Ramkinker Medical Institute Purani Basti, Raipur, CG Infectious Diseases Ashok Gupta MD FIAP Associate Professor Pediatrics SMS Medical College, Jaipur Dermatology Arun Agrawal MD FIAP FIAMS Chandra Laxmi Hospital Ghaziabad, UP
3Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
B-3 EMCA House, 23/23B Ansari Road, Daryaganj
New Delhi 110 002, India Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021,
+91-11-23245672, Rel: +91-11-32558559 Fax: +91-11-23276490, +91-11-23245683
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Spotters in Pediatrics
© 2008 Anoop Verma
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher.
First Edition: 2008
9788184482492
Typeset at JPBMP typesetting unit
Printed at Replica Press
4
To
My grandfather late Dr GP Shrivastava, MRCP, DTMH, from whom I imbibed the interest in clinical medicine and zeal to remain updated in office practice.
My father late Dr BBL Verma and motherlate Suman Lata Verma from whom I learned to aim high and follow the path of voice within.
My wife Rashmi, daughter Swapnil and son Shantanu and my whole family are my energy pillars, and my confidence
5Contributors 7Foreword
Dear Dr Anoop Verma,
I congratulate you for an excellent work and here is my comment.
“I am aware of your zest to capture images of patients including videos that I have myself witnessed during your academic presentations at various conferences. I am sure one stores what one sees more than what one just reads and that is how we learn better from patients rather than mere textbooks. This compilation of large number of images would certainly help all of us to memorise those conditions that in turn would help us to spot them quickly.
I appreciate your efforts to disseminate knowledge in unique way. I strongly recommend for each one of us to make best use of such a ready reckoner. Short relevant text accompanying the images is a bonus.”
With regards and best of wishes
Prof. YK Amdekar (Retd)
Pediatrics Dept., JJ Hospital, Mumbai
Hon. Prof of Pediatrics, Jaslok Hospital, Mumbai
8Foreword
Childhood illnesses constitute as major public health problem in many developing countries including India. There are innumerable emerging and re-emerging diseases, genetic and metabolic disorders and rare syndromes, which are extremely difficult to diagnose. A large number of these diseases especially infectious if diagnosed early can save the lives of these babies. Genetic disorders always remain an enigma and diagnostic dilemma to majority of clinicians. There are innumerable dermatological conditions in children, which baffles the clinician.
Normal physiological conditions in the newborn are often regarded as pathological and cause panics in the minds of the parents and some physicians. It is, therefore, important to differentiate normal from abnormal conditions in the newborn. I earnestly appreciate the sincere effort being done by Dr Anoop Verma in putting together excellent photographs of high quality in the book “Spotters in Pediatrics” which would prove to be a useful readymade armamentarium in the hands of Pediatricians and Physicians.
I have known Dr Verma as one of the most dynamic and hardworking pediatrician in the country. He has excellent organizational capacity and in a short period of time attained various important positions in Indian Academy of Pediatrics in both State and at National level. This book will be an extremely useful guidebook for all clinicians. The book contains very useful chapters of infectious diseases, neonatology, genetic and metabolic disorders, nephrology, rare syndromes and dermatological conditions in children.
By bringing out this important book, Dr Verma has made significant contribution in the field of Pediatrics bridging the gap of a near famine of relevant topics in this field. I am sure, the book will find a place in the desktop of many clinicians in the country. I wish Dr Anoop Verma all success in his further effort in this direction.
AK Dutta
Vice-Principal, Director Professor and HOD, Pediatrics
Kalawati Saran Children's Hospital
Lady Hardinge Medical College
New Delhi
9Foreword
It is a matter of great privilege and pride for me to learn about the launching of the publication Spotters in Pediatrics by Dr Anoop Verma, ex-National Vice-President of IAP. The field of pediatrics has tremendously expanded in the last decade with expertise in various sub-specialties. In addition the recent advances in the field of perinatology, newborn care, molecular biology, drug therapy, genetics and emerging-reemerging infection have added new dimensions in the understanding the childhood problems for the practicing pediatrician. Thus, it has become necessary for the medical professional to update himself with the recent know-how in the field of newborn and childhood diseases from the diagnostic and management point of view. This book is an excellent collection of clinical photographs of common to rare pediatric diseases along with short text for ready reference. It will definitely prove to be a guiding source of knowledge for the busy practicing pediatrician and will serve as ready reckoner. I would like to congratulate Dr Anoop Verma for this innovative academic venture.
With personal regards and best wishes
Uday Bodhankar
Deputy Secretary General CAMHADD UK
International Council Member ASPR Japan
Chairman ICMCH and INSPCAN India
Hon. Prof. of Pediatrics – IGMC Nagpur
Past President IAP / ISTP / SCM – IPA
Ramdaspeth, Nagpur 440012 MS, INDIA
Ph: (R) 0091- 712- 2425020 / 2445554
(H) 0091 -712- 2459090 / 2422505
FAX : 0091- 712- 2428145 / 2421017
10Foreword
One of the essential requirements of scientific progress and research is correct documentation of facts. In western countries scientific data and observation were meticulously recorded and stored. Out of 2.1 billion children below first year of life, the 3/4th are in developing countries, have very high under-five mortality.
Pediatrician in India has contributed a lot in reducing infant mortality and in various childhood illnesses. Contributions of Indians in world literature are still below expectation. “Spotters in Pediatrics” by Dr Anoop Verma will fill this gap to great extent.
Dr Anoop Verma is very hard working and sincere pediatrician with a habit of recording observations, which has given rise to this monograph for which he deserves great compliments. Spotters in Pediatrics should find its place in bookshelf of practicing pediatricians, graduates in pediatrics and general practitioners. It should stimulate them for good record and for bringing more books like this in future.
Padmashree AT Dabke md phd
Dean, Professor and Head (Rtd)
Department of Pediatrics
Pt JNM Medical College, Raipur
11Preface
Pediatrics is a fascinating branch, not because we deal with innocent patients but because we draw conclusions from what parents say and what we assess in examination of patient. It is more or less a role of detective. To become a good detective it is not only to read the text thoroughly but also to memorise and search the abnormalities.
“A picture is worth a thousand words, and a video is worth a thousand pictures. I cannot define an elephant unless I have seen one.” A glimpse of clinical condition is sufficient to repercuss your brain later, when you come across similar condition in future.
The art of making diagnosis by gestalt is not inherited; it needs repeated practice mixed with interest in it. The more you see a condition, the more you go through the text, less is the chance, the condition is escaped your recognition. Experience is not one day job, it is gradual building of memory of variety of cases you come across over the years.
It is an old saying you are never late in medical practice. The journey to this fascinating subject can begin at any point of time, provided you have constant zeal and persistent interest in this subject. In clinical practice we must wear the spectacle of astute clinical observer and behave like assiduous and prolific recorder of observation.
The syndromic child is most of the time considered a gift of God and hence, further treatment by parents comes to an end. It is on the part of treating physician to counsel such parents and make them aware of the condition and accordingly encourage future course of disease and its inheritance. There are certain conditions which have strong possibility and probability to recur in future generation, on the contrary, there are conditions which almost occurs once (sporadic mutation). The concept of counseling should spread to all parents of such children. Rarely do we find parents who are concerned of their child's disease and its course.
The usefulness of a clinical atlas in medicine is known since ages. The present shape of “Spotters in Pediatrics” is the result of years of devotion and hard work. With its classified and authoritative format this atlas supplies the answer to question that may arise during examination or consultation, giving advice on symptoms, diagnosis and therapeutic measures.
We hope that the detailed but concise information given in this atlas will prove of value to students and experienced practitioners alike.
Anoop Verma
12Acknowledgements
One's body may be handsome, wife beautiful, fame excellent and varied, and wealth like unto Mount Meru; but if one's mind be not attached to the lotus feet of Guru, what thence, what thence, what thence ?
Adi Shankara
Guruvastakam, Verse 1
In my development as a pediatrician, apart from my destiny, there was huge share of my devoted teachers, who have virtually paved my way to clinical pediatrics. My deep regards and respect to my teachers Late Prof DS Dave, Prof NG Prasan, Padmashree Prof AT Dabke and Prof Ashok Rawat. I have got great encouragement and blessings from stalwarts in pediatrics Prof YK Amdekar, Prof AK Dutta, Prof Uday Bodhankar, Prof HP Singh. From my core of heart I convey my sincere gratitude to them.
I convey my thanks to our inspirational National President of IAP 2007 Dr Naveen Thacker, who virtually introduced me to publisher, and given me the initial push.
I am indebted to our past National Presidents Dr Raju Shah and Dr Nitin Shah for keeping me on track by their able guidance.
My hearty thanks to my chapter editors Sanjay Sharma, Pulak Parag, Navneet Jain, Arun Agrawal, Ashok Gupta and Ramesh Bhatt. Their infectious interest has virtually lessened my workload.
To come up with plethora of clinical photographs is not easy task, but due to important contributions from contributors. I convey my deep sense of regards to the contributors of this book.
A sense of deep regards to my colleagues at Chhattisgarh and my friends, namely DK Sur, ML Rathi, KP Sarbhai, Vijay Makhija, Ashwani Agrawal, SK Mandrik, KW Deoras, Pradeep Sihare, Rakesh Sahu, Madhu Shree Deshpande, Ashok Mehta and Lokesh Shadangi their powerful support, encouragement and guidance has always lifted my morale. I am indebt to all of them.
My due regards to M/s Jaypee Brothers Medical Publishers (P) Ltd., especially Shree Tarun Duneja, General Manager, (Publishing), for his interest and support.
Last but not the least, my wonderful colleague and friend Shyam Sharma, who has kept me free to complete this life time work.
Lastly, I am overwhelmed to convey my gratitude to my whole family Sudhir, Nalini, Manoj, Aarti, Soumiya, Anuj and Siddhi for creating encouraging milieu favorable to this work.