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Recent Advances in Pediatrics (Volume 21): Hot Topics
Suraj Gupte
SECTION 1: NEONATOLOGY
1:
Long-term Follow-up of High-risk Neonates
INTRODUCTION
WHO IS A HIGH-RISK NEONATE?
WHY THESE BABIES NEED A FOLLOW-UP?
WHO SHOULD DO THE FOLLOW-UP?
WHAT TO FOLLOW-UP?
Growth and Nutrition
WHICH POSTNATAL CHART TO FOLLOW?
POST-DISCHARGE NUTRITION
COMPLEMENTARY FEEDING OF PRETERM NEONATES
NEUROLOGICAL OUTCOME
Amiel-Tison Scale
Gross Motor Functioning
Development Assessment
How Long to Use Corrected Age
Hearing and Visual Assessment
Hearing Assessment
Criteria for Hearing Screening
Visual assessment
Recommendations
Cognitive Abilities, Educational Performance and Behavioral Assessment
Cognitive Impairment
Behavioral Assessment
Language and Speech Assessment
Neuroimaging—Which One to Use and Why and When?
USG/CT/MRI
USG
Prediction of Long-term Outcome
CT Scan
MRI
Term baby with encephalopathy—role of USG, CT scan and MRI and follow-up
Immunization
EARLY INTERVENTION: DO WE NEED?/WHEN?/HOW?
Metabolic Syndrome
SUMMARY AND CONCLUSION
2:
Infection, Inflammation, and Perinatal Asphyxia
INTRODUCTION
PATHOPHYSIOLOGY OF ASPHYXIA
ROLE OF INFLAMMATION
PERINATAL MODELS OF HYPOXIC-ISCHEMIC INJURY
POTENTIATION OF PERINATAL HYPOXIC-ISCHEMIC BRAIN INJURY BY INFLAMMATION PROVOKED BY INFECTION
INFLAMMATION AND BRAIN INJURY IN HUMAN INFANTS
BIOCHEMICAL MECHANISMS OF OLIGODENDROGLIAL DEATH WITH HYPOXIA-ISCHEMIA
Intrinsic Vulnerability of Early Differentiating Oligodendroglia to Hypoxic-ischemic Injury
Infection or Inflammation as an Additional or Potentiating Mechanism
Gram-negative Infection, Endotoxin (Lipopolysaccharide), and White Matter Injury
Innate Immunity and the Relation of Systemic Inflammation to the Brain
Central Role of Microglia
Hypoxia-ischemia and Maternal/Fetal Infection: Potentiating Insults
Potentiation of Adverse Systemic and Circulatory Effects by Combined Infection or Inflammation and Hypoxia-ischemia
Microglia as a Convergence Point in the Potentiation of White Matter Injury by Infection or Inflammation and Hypoxia-ischemia
DIAGNOSIS OF SEPSIS IN ASPHYXIA CLINICAL
INVESTIGATIONS
SUMMARY AND CONCLUSION
3:
Neonatal Transport
INTRODUCTION
STATUS OF NEONATAL TRANSFERS IN INDIA
TYPES OF TRANSPORT
INDICATIONS FOR TRANSPORT
ORGANIZATION OF A NEONATAL TRANSPORT SERVICE
Communication
History
Delivery Room History
Maternal History
Delivery Room Events
Personnel
Equipment
Necessary equipment for the transport of sick newborn infants
Clinical Stabilization Before Transfer
Infant Care During the Journey
Monitor
Communication and Documentation
Quality Assurance
Financial Implications
Way forward
4:
Congenital Diaphragmatic Hernia
INTRODUCTION
TYPES
EMBRYOLOGY
CAUSES
Environmental Causes
Chromosomal Abnormalities
CLINICAL MANIFESTATIONS
DIAGNOSIS
Prenatal Testing
Postnatal Diagnosis
Differential Diagnosis
MANAGEMENT
Prenatal Treatment
Postnatal Treatment
PROGNOSIS
SUMMARY AND CONCLUSION
5:
Neonatal Anemia
INTRODUCTION
Etiopathogenesis
CAUSES OF NEONATAL ANEMIA
Blood Loss
Increased Red Cell Destruction
Intrinsic Causes
Extrinsic Causes
Decreased RBC Production
CLINICAL FEATURES
DIAGNOSTIC EVALUATION
History
Peripheral Blood Picture in Anemia
Mean Corpuscular Volume (MCV)
Iatrogenic Blood Loss
Fetomaternal Hemorrhage
Hereditary Spherocytosis
Glucose-6-Phosphate Dehydrogenase Deficiency
Thalassemia
GENERAL GUIDELINES OF TREATMENT AND PREVENTION OF NEONATAL ANEMIA
Iron Supplementation
Blood Transfusion
Erythropoietin
Delayed Cord Clamping
Autologous Placental Transfusion
FOLLOW-UP OF NEONATAL ANEMIA
SUMMARY AND CONCLUSION
6:
Intrauterine Growth Retardation
INTRODUCTION
DEFINITION
INCIDENCE
ETIOLOGY
DIAGNOSIS
MANAGEMENT
Delivery
Neonatal Care
COMPLICATIONS
LONG-TERM CONSEQUENCES OF Intrauterine growth retardation
SUMMARY AND CONCLUSION
7:
Neonatal Sepsis: Trends in Diagnosis and Management
INTRODUCTION
NEWER DIAGNOSTIC TESTS
Antenatal Diagnosis
Amniotic Fluid Tumor Necrosis Factor α
Proteomics
Postnatal Diagnosis
Acute Phase Reactant
C-reactive Protein
Procalcitonin
Serum Amyloid A
Inter-alpha Inhibitor Protein
Lipopolysaccharide-binding Protein
Cell Surface Marker
CD11b
CD64
CD69
HLA-DR
Granulocyte Colony Stimulating Factor
Cytokines
IL-6
IL-8
TNF-α
IL-1β and IL-1ra
Nucleated RBC
Molecular Genetics
Polymerase Chain Reaction
Molecular Proteomics
P- and E-selectins
uPA
Interleukin 2 Soluble Receptor α (IL-2sRα)
IL-18
THERAPEUTIC ASPECTS
Supportive Treatment
Antimicrobial Treatment
Recent Reserve Antibiotics
Immunomodulatory Therapy
Blood Exchange Transfusion
Granulocyte Transfusion
Low Dose Steroid Therapy
Bactericidal/permeability increasing protein
Nitric Oxide Inhibitor
Granulocyte-colony Stimulating Factor (G-CSF) and Granulocyte Macrophage-colony Stimulating Factor (GM-CSF)
IMMUNOGLOBULIN
Pentoxifylline
Probiotics
Glutamine
Lactoferrin
Recombinant Human Protein C
SUMMARY AND CONCLUSION
8:
Acute Renal Failure in Neonates
INTRODUCTION
DEFINITION
INCIDENCE
KIDNEY AND MATURITY
GENETIC BACKGROUND FOR ARF
PATHOPHYSIOLOGY
CLINICAL EVALUATION
Family History
Drugs
Antenatal and Perinatal Factors
Severe Dehydration
Cardiac Function
Severe Sepsis
Thrombosis
EFFECT OF HYPOXIA
MANAGEMENT
General Approach
Maintenance of Fluid Balance
Fluid Challenge
Lasix
Fluid Restriction
Maintenance of Electrolyte Balance
RENAL REPLACEMENT THERAPY
Peritoneal Dialysis
Limitations for the Peritoneal Dialysis
PROGNOSIS
SUMMARY AND CONCLUSION
9:
Air Leaks in Newborns: A Neonatologist's Nightmare!
INTRODUCTION
INCIDENCE
PATHOPHYSIOLOGY
RISK FACTORS
PNEUMOTHORAX
Diagnosis
Management
PULMONARY INTERSTITIAL EMPHYSEMA
Diagnosis
Treatment
PNEUMOMEDIASTINUM
PNEUMOPERICARDIUM
OTHER AIR LEAKS
SUMMARY AND CONCLUSION
10:
Developmentally Supportive Care in Preterm Neonates
INTRODUCTION
DEVELOPMENTALLY SUPPORTIVE CARE
DEVELOPMENT OF THE BRAIN
Development of Visual System
Development of Auditory System
CONCEPTUAL MODEL OF DEVELOPMENTALLY SUPPORTIVE CARE
Measures for DSC
Protected Sleep
Assessment and Management of Pain and Stress24–26
Positioning, Feeding and Skin Care27–29
Family-centered Care30,31
Provision of Healing Environment
NEWBORN INDIVIDUALIZED DEVELOPMENTAL CARE AND ASSESSMENT PROGRAM
Methods of NIDCAP
Observation
Assessment
Care Plan
Scientific Evidence for NIDCAP
Family-centered Care
Principles of FCC as suggested by American Academy of Pediatrics44
SUMMARY AND CONCLUSION
11:
Proteomics in Fetal and Neonatal Medicine
INTRODUCTION
DEFINITION
OTHER DEFINITIONS RELATED TO PROTEOMICS
DIFFERENCES BETWEEN TRADITIONAL PROTEIN BIOCHEMISTRY AND PROTEOMICS
TOOLS OF PROTEOMICS10
TECHNIQUES FOR PROTEOMIC ANALYSIS
APPLICATIONS OF PROTEOMICS
SCOPE OF PROTEOMICS
Application of Proteomics in Pregnancy Research
Amniotic Fluid Proteomic Studies for the Detection of Fetal Aneuploidies
Proteome Studies in Preeclampsia, Intrauterine Growth Restriction, Preterm Labor, and Intra-amniotic Infection
Use of Proteomics in Diagnosis of Infection and Autoimmune Diseases
Proteomics and HIV Infection
Proteomics and Tuberculosis, Malaria, and Severe Acute Respiratory Syndrome
Proteomics and Autoimmune Disorders
Proteomics and Cancer
Proteomics in Vaccine Development
Antibacterial Vaccine
Antiviral Vaccines
Cancer Vaccines
Proteomics for Prediction of Clinical Outcome
SUMMARY AND CONCLUSION
SECTION 2: NUTRITION/MALNUTRITION
12:
Infant Feeding Revisited
INTRODUCTION
WHO AND UNICEF: OPTIMAL INFANT FEEDING GUIDELINES
Breastfeeding
How frequently and how long should the child be breastfed?
How should the mother hold the child while breastfeeding?
How baby suckles from the breast (Fig. 12.1):
Baby's Position
Mother's Position:
What is the cause of cracked/sore nipples? what is the remedy?
How to know that the baby is getting enough breast milk?
Should breastfeeding be stopped during mother's illnesses?
Is it all right to use a bottle for giving water or milk to a child?
How should a working woman combine work with breastfeeding?
Complementary Feeding and Infant Nutrition
Definition and Logistics
Advantages for the Baby
Advantages to the Mother
Why not introduce complementary foods before end of six months?
Why breastfeed in the second year of life
Guiding principles for complementary feeding of the breastfed child.20
Care and Recommendations While Preparing Complementary Food24,25
Wrong Practices
Recommendations for Micronutrient Supplementation
Vitamin A26
Iron27,28
Iodine29
Zinc30
Local Adaptation of Complementary Feeding Recommendations31
Infants 6–11 months
Children 12–23 months
Appropriate Foods for Complementary Feeding32
Reminder
SUMMARY AND CONCLUSION
13:
Vitamin A Deficiency Disorders: Diagnosis and their Assessment
INTRODUCTION
MAGNITUDE OF PROBLEM
Global Situation
Situation in India
CAUSES OF VITAMIN A DEFICIENCY DISORDERS3,4
Ecological Factors
Social Factors
Economic Factors
Clustering
Host Factors
Age
Sex
Feeding Practices
Disease Patterns
Periods of Increased Physiological Need
Breastfeeding
Other Factors Affecting Vitamin A Deficiency
HEALTH CONSEQUENCES OF VITAMIN A DEFICIENCY DISORDERS
CLINICAL MANIFESTATIONS
Night Blindness
Conjunctival Xerosis
Bitot's Spots
Corneal Xerosis
Corneal Ulceration
Keratomalacia
SURVEY FOR VAD IN COMMUNITIES
Assessing VAD Prevalence
Note
VADD is a Public Health Problem
Demographic and ecological indicators
Indicators for VAD Survey3,4
Purposes of VAD Survey
Factors in Selecting Groups to Measure
Vulnerability
Representativeness
Appropriate Groups to Measure
Selecting Indicators
Technical Feasibility
Cost
Performance
Presentation and Interpretation of Survey Results
Definition of a Public Health Problem
Indicators of VAD
Clinical Indicators
Subclinical Indicators
Biochemical Indicators
Breast milk Vitamin A Concentration
Relative Dose Response Tests (RDR and MRDR)
Serum 30-day Dose Response Test (+S30DR)
Histological Indicator
Identifying High-risk Areas/Populations for Interventions
Ecological Indicators
Socioeconomic Indicators
Measuring Progress Towards Long-Term Micronutrient Goals
BASIC STEPS IN PLANNING A COMMUNITY SURVEY FOR VITAMIN A DEFICIENCY
Review of situation and resources
Definition of the objectives for the survey of VAD
Survey Design
RECENT ISSUES IN VITAMIN A SUPPLEMENTATION TO CHILDREN IN INDIA8–10
Vitamin A Supplementation Program
Time to Phase out the Universal Program
No Need, for Deficiency
Poor Evidence for Reduction in Child Mortality11
Problems with VAS Supplementation
RECOMMENDATION ON ELIGIBILITY OF CHILDREN FOR VITAMIN A SUPPLEMENTATION PROGRAM: IAP SUBSPECIALTY CHAPTER ON NUTRITION
VA-RELATED DEATHS IN ASSAM, INDIA DURING 200113–17
The Judicial Enquiry of VA-related Deaths18,19
Investigations of Assam Human Right Commission
Aftermath of Assam Episode
What Needs to Be Done for Prevention of VAD
SUMMARY AND CONCLUSIONS
14:
Nutritional Deficiencies in Obesity: The Cause or the Effect?
INTRODUCTION
VITAMIN D, OBESITY, AND THE METABOLIC SYNDROME
ROLE OF FAT CELLS
OTHER VITAMINS AND OBESITY
IRON AND OBESITY
ZINC AND OBESITY
MAGNESIUM AND OBESITY
PERINATAL NUTRITION, LONG CHAIN POLYUNSATURATED FATTY ACIDS, AND OBESITY
HORMONAL INFLUENCE ON ENERGY BALANCE
ROLE OF LEPTIN IN OBESITY
PREVENTIVE AND TREATMENT STRATEGIES
SUMMARY AND CONCLUSION
15:
Severe Acute Malnutrition: Therapeutic Strides
INTRODUCTION
DEFINITIONS AND CLASSIFICATION
TREATMENT OF SAM
Facility-based or Inpatient Treatment Model
General Principles for Routine Care (The ‘10 Steps’)
Treatment
Monitor
Prevention
Monitor
Prevention
Treatment
Monitor Progress of Rehydration
Prevention
Give
Emergency Treatment of Shock and Severe Anemia
Shock in Severely Malnourished Children
Severe anemia in malnourished children
Treatment of Associated Conditions
Vitamin A deficiency
Dermatosis
Parasitic/Worm Infestations
Continuing Diarrhea
Tuberculosis (TB)
Failure to Respond to Treatment
High mortality
Low weight gain during the rehabilitation phase
Discharge Before Recovery is Complete
The child
The Mother/Carer
Local Health Workers
Community Based Management of Undernutrition
Ready-to-useTherapeutic Food
Environmental and Child Care Issues
SUMMARY AND CONCLUSION
Acknowledgments
SECTION 3: GASTROENTEROLOGY/HEPATOLOGY
16:
Gastroesophageal Reflux Disease
INTRODUCTION
Mechanisms of Development
Clinical Manifestations
COMPLICATIONS
Gastrointestinal Complications
Hematological Complications
Neurobehavioral Complications
Respiratory Complications
DIAGNOSIS
Diagnostic Tests
Esophagogastroduodenoscopy with Biopsy
Esophageal Manometry
Test for the Diagnosis of Reflux Complications
Video Fluoroscopic Swallowing Study
Technetium 99m Scan
Bronchoalveolar Lavage of Lipid Laden Macrophages
Histopathology
MANAGEMENT
Positional Therapy
Medical Therapies
Proton Pump Inhibitors
Surgical Therapy
SUMMARY AND CONCLUSION
17:
Chronic Abdominal Pain
INTRODUCTION
EPIDEMIOLOGY
ETIOLOGY
Organic Causes of Chronic Abdominal Pain
Functional Gastrointestinal Disorders
Functional Dyspepsia
Irritable Bowel Syndrome
Abdominal Migraine
Functional Abdominal Pain
MANAGEMENT
TREATMENT MODALITIES
Pharmacological Management
Dietary Modifications
Cognitive Behavior Therapy
Parent Education and Treatment Goals
Responsibilities of the Physician: The Therapeutic Relationship
PROGNOSIS
SUMMARY AND CONCLUSION
18:
Acute Liver Failure
INTRODUCTION
DEFINITION AND CLASSIFICATION
ETIOLOGY AND EPIDEMIOLOGY
PATHOGENESIS
CLINICAL FEATURES
Diagnostic Work-up
GOALS OF MANAGEMENT
Fluid and Electrolytes
Intubation
Management Following Intubation
Cerebral Edema
Infection
Coagulation
Renal Failure
Nutrition
Etiology Specific Treatment (Table 18.7)
Liver Support Systems
N-acetylcysteine
Liver Transplantation
OUTCOME32–36
SUMMARY AND CONCLUSION
SECTION 4: DEVELOPMENTAL PEDIATRICS/CHILD PSYCHIATRY
19:
Attention Deficit Hyperactivity Disorder
INTRODUCTION
HISTORICAL ASPECTS
ASSESSMENT AND DIAGNOSIS
PREVALANCE AND GENDER DIFFERENCES
COMORBIDITY
ETIOLOGIC THEORIES
TREATMENT
SUMMARY AND CONSLUSION
20:
Conversion Disorder and Hysteria—A Cry for Help!
INTRODUCTION
DIAGNOSTIC CRITERIA
CAUSES
SYMPTOMS
DIAGNOSIS
Diagnostic Issues
Factors Suggesting a Diagnosis of Conversion Disorder1
Medical Conditions that Mimic Conversion Symptoms1
TREATMENT1
Medications
Psychotherapy
Inpatient Treatment
Alternative and Complementary Therapies
PROGNOSIS
PREVENTION
Office Practice Pearls
ACKNOWLEDGMENTS
SECTION 5: ENDOCRINAL AND METABOLIC DISORDERS
21:
The Metabolic Syndrome—Stomp the Spark
INTRODUCTION
BACKGROUND
PROBLEM STATEMENT
COMPONENTS OF METABOLIC SYNDROME AND CUT-OFF VALUES
WHO WORKING DEFINITION5
NCEP-ATP III Criteria6
American Association of Clinical Endocrinologists’ Criteria7
International Diabetic Federation Criteria8
DEFINITION OF METABOLIC SYNDROME IN CHILDREN AND ADOLESCENTS
MEASUREMENT OF OBESITY
Reference Charts for Children
ETIOPATHOGENESIS
BARKER'S HYPOTHESIS
MANAGEMENT OF METABOLIC SYNDROME
Lifestyle Modification
Secondary Prevention
Therapeutic Management for the Individual Components9,58,63,91
Specific Metabolic Risk Factors
Tertiary Intervention
SUMMARY AND CONCLUSION
22:
Pediatric Thyroid Disorders
INTRODUCTION
THYROID IN THE PAST
THYROID EMBRYOGENESIS AND PHYSIOLOGY
PEDIATRIC HYPOTHYROIDISM
Congenital Hypothyroidism
Permanent Hypothyroidism
Clinical Features of Congenital Hypothyroidism
Acquired or Juvenile Hypothyroidism
General Principles in Treatment of CH and JH
PEDIATRIC HYPERTHYROIDISM
Neonatal Hyperthyroidism
Treatment of Congenital Hyperthyroidism
Acquired Hyperthyroidism
Treatment of Acquired Hyperthyroidism
Antithyroid Medications
Radioactive Iodine
Surgery
Thyroid Storm
Thyrotoxic Periodic Paralysis (TPP)
GOITER IN CHILDREN
Congenital Goiter
Acquired Goiter
Thyroid Cancers21
Well Differentiated Thyroid Cancers (WDTCs)
Medullary Thyroid Cancer (MTC)
SUMMARY AND CONCLUSION
SECTION 6: CRITICAL CARE
23:
Management of Raised Intracranial Pressure
INTRODUCTION
PATHOPHYSIOLOGY
Monroe-Kellie Doctrine
Pressure Volume Relation of Cranial Vault (Compliance)
Cerebral Perfusion Pressure and Cerebral Blood Flow
Autoregulation of Cerebral Blood Flow
Effect of Blood Gases on ICP
Causes
SIGNS AND SYMPTOMS
NEUROIMAGING
NEUROCRITICAL CARE MONITORING
ICP Monitoring
Noninvasive Monitoring
Jugular Venous Saturation
MANAGEMENT
Initial Stabilization
Airway Management
Breathing
Circulation
Management Strategies to Decrease ICP and Increase CPP
Position of the Child
Sedation and Analgesia
Decreasing the Metabolic Rate
CSF Drainage
Osmotherapy
Mannitol
Hypertonic Saline (3% Saline)
Hyperventilation
Barbiturates
Role of Surgery
Hypothermia
Steroids
Supportive Therapy
Fluid Management
Ventilation
SUMMARY AND CONCLUSION
24:
Acute Renal Failure in Children
INTRODUCTION
ETIOLOGY AND DIAGNOSIS OF ACUTE KIDNEY INJURY
ETIOLOGY OF ARF
Prerenal Injury
Intrinsic Renal Disease Hypoxic/ischemic Acute Kidney Injury
Rapidly Progressive Glomerulonephritis
Vascular Insults
Obstructive Uropathy
Classification (Table 24.1)
RECENT ADVANCES IN MANAGEMENT OF ACUTE KIDNEY INJURY IN CHILDREN
PROGNOSIS OF ACUTE KIDNEY INJURY
SUMMARY AND CONCLUSION
25:
Toxic Shock Syndrome
INTRODUCTION
HISTORY AND EPIDEMIOLOGY
CLINICAL PATHOGENESIS
“Superantigen” Stimulation of the T-Cell Receptor
Clinical Manifestations and Diagnosis
LIFE-THREATENING COMPLICATIONS OF Toxic shock syndrome
MANAGEMENT
Airway Management and Respiratory Control
Severe Hypovolemic Shock
Role and Choice of Antibiotics
SUMMARY AND CONCLUSION
26:
Management of Diabetic Ketoacidosis
INTRODUCTION
PATHOPHYSIOLOGY3,4
Biochemical Criteria for the Diagnosis of DKA3
Categories of DKA
Clinical Features of DKA
Emergency Management
General5
Confirm the Diagnosis
Initial Investigations
Full Clinical assessment5
Hypotension is a Very Late Sign
Fluids and Salts3,4
Fluid replacements5
Insulin3–5
Potassium3–5
Phosphate3,4
Acidosis3,4
Anticoagulant6
Continuing Management4,5
Cerebral Edema
Clinical Features3
Management4,5–7
Other Complications4,5
Calculations3
SUMMARY AND CONCLUSION
SECTION 7: VACCINES
27:
Edible Vaccines
HISTORY
CONCEPT OF EDIBLE VACCINES
TECHNOLOGY
VECTOR
ADMINISTRATION OF EDIBLE VACCINES
FATE OF EDIBLE VACCINES IN THE BODY
SECOND GENERATION EDIBLE VACCINES
TARGETING STRATEGY
Enhancing Immunogenicity
EDIBLE VACCINES USING RECOMBINANT TECHNOLOGY
IMMUNITY MECHANISM
PASSIVE IMMUNIZATION
ADVANTAGES
CONCERNS ON EDIBLE VACCINES
CHALLENGES
FUTURE OF EDIBLE VACCINES
SUMMARY AND CONCLUSION
28:
Newer and Future Vaccines
INTRODUCTION
UNMET MEDICAL NEEDS
TECHNOLOGIES FOR NEW AND IMPROVED VACCINES
NEWER VACCINES FOR INDIA
NEED FOR NEW VACCINES9–11
CLASSIFICATION OF VACCINES12
TIMELINE OF VACCINES13, 14
NEW AND UNDER-UTILIZED VACCINES
NEW LICENSED VACCINES15
VACCINES IN THE PIPELINE9
DNA VACCINE
VACCINES IN CANCER
FUNGAL VACCINES
ANTIOBESITY VACCINES
CHIKUNGUNYA VACCINE
SCHISTOSOMIASIS AND HOOKWORM VACCINES
ORAL RABIES VACCINE
NEW VACCINE FOR Tuberculosis
FUTURE VACCINES IN INDIA
Dengue Virus Vaccines
Hepatitis E Virus Vaccine
Human Immunodeficiency Virus Vaccine
Leishmania Vaccine
Leprosy Vaccine
Malaria Vaccine
Recent Antitubercular Vaccine
Bird's (Avian) Flu
Leptospirosis Vaccine
H. pylori Vaccine
THE IMPACT OF IMMUNIZATION
By the year 2020
SUMMARY AND CONCLUSION
SECTION 8: PEDIATRIC PHARMACOTHERAPY
29:
Pediatric Pharmacotherapy: Special Aspects in Nutshell
INTRODUCTION
DEVELOPMENTAL PHARMACODYNAMICS2-5
Variation with Chronological Age
Adverse Drug Reactions Specific to Pediatric Age Group
PHARMACOKINETICS2–5
Drug Absorption and Bioavailability
Absorption from the GIT
Absorption from the GIT
Absorption from the Skin
Absorption from the Intramuscular Site
Absorption from the Rectum
Drug Distribution
Metabolism
Phase I Metabolism (Activity)
Phase II Metabolism (Activity)
Drug Elimination
Renal Excretion
PHARMACODYNAMICS AND RECEPTOR SENSITIVITY
Drug Dosing
TOWARDS RATIONAL DRUG THERAPY
SUMMARY AND CONCLUSION
30:
Pharmacotherapy in Child Psychiatry
INTRODUCTION
BASELINE ASSESSMENTS OF PSYCHIATRIC SYMPTOMS
CHILDHOOD PHARMACOKINETICS
PSYCHOPHARMACOLOGICAL TREATMENT IN CHILDREN AND ADOLESCENTS
DISRUPTIVE BEHAVIOR DISORDERS
Attention-deficit/Hyperactivity Disorder
Stimulant Drugs
Non-stimulant Drugs
Atomoxetine
Tricyclic Antidepressants
Bupropion
α-Agonists
CONDUCT DISORDER
MOOD DISORDERS
Major Depressive Disorder
Suicidality
Dysthymia
Bipolar Disorder
Pharmacotherapies for Bipolar Disorder
Lithium
Anticonvulsants
Atypical Antipsychotics
Anxiety Disorders
Obsessive-compulsive Disorder
Post-traumatic Stress Disorder
Other Anxiety Disorders (Separation Anxiety Disorder, Generalized Anxiety Disorder, Social Phobia, Specific Phobia, Panic Disorder, Agoraphobia without Panic Disorder)
Schizophrenia
Rapid Tranquillization of Children and Adolescents with Severe Maladaptive Aggression
Substance Use Disorders
Pervasive Developmental Disorders
Sleep Disorders
Insomnia
Enuresis
Pharmacotherapy for Enuresis
Desmopressin
Imipramine
Sleep Terror Disorder and Sleepwalking Disorder
Eating Disorders
Tic Disorders
Mental Retardation
ENDOCRINE AND METABOLIC EFFECTS OF PSYCHOTROPIC MEDICATIONS
Antipsychotics
Weight Gain and Metabolic Issues
Prolactin
Psychostimulants and Atomoxetine
Mood Stabilizers
Lithium
Valproate
PSYCHOPHARMACOLOGICAL TREATMENT FOR VERY YOUNG CHILDREN
ADHD
Major Depressive Disorder
Bipolar Disorder
Anxiety
Pervasive Developmental Disorders
Primary Sleep Disorders
SUMMARY AND CONCLUSION
31:
Pharmacotherapy of Pediatric Malaria
INTRODUCTION
AIMS AND OBJECTIVES
DRUG THERAPY
Chloroquine-sensitive Malaria
Chloroquine-resistant Falciparum Malaria
Multidrug-resistant Falciparum Malaria
Complicated and Severe Malaria
SALIENT FEATURES OF KEY ANTIMALARIAL DRUGS4,6,12,13
Sulfamethoxypyrazine with Pyrimethamine (Metakelfin)
Indications
Available as
Dose
ADRs
Contraindication
Precaution
Sulfadoxine with Pyrimethamine (Malocide, Croydoxin FM)
Indications
Available as
Dose
ADRs
Contraindication
Precaution
Amodiaquine (Camoquin)
Indications
Available as
Dose
ADRs
Contraindications
Caution
Artemether (Arte-plus, Lumerax)
Indication
Available as
Dose
ADRs
Contraindications
Drug Interaction
Caution
Indication
Available as
Dose
ADRs
Contraindications
Drug Interaction
Caution
Chloroquine Sulfate (Nivaquine, Lariago, Resochin
Indications
Available as
Dose
Prophylactic dose
ADRs
Contraindications
Drug Interactions
Caution
Indications
Available as
Dose
Contraindications
Drug Interactions
Caution
Indications
Available as
Dose
ADRs
Contraindications
Drug Interactions
Caution
Quinine Sulfate (Quininga)
Indications
Available as
Dose
ADRs
Contraindications
Drug Interactions
Caution
SUMMARY AND CONCLUSION
INDEX
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