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Recent Advances in Pediatrics (Volume 19): Hot Topics
Suraj Gupte
PART 1: SPOTLIGHT: MEDICOLEGAL ASPECTS OF PEDIATRICS
CHAPTER 1:
Sexual Violence against Adolescents
INTRODUCTION
ADOLESCENT SEXUALITY
PUBERTY
Indian Academy of Pediatrics’ Proposal
Syllabus for Adolescent Health Education
Adolescent Friendly Health Center Services
Criteria for Adolescent Friendly Health Worker
HISTORY FROM THE ADOLESCENT
Documentation
Photographic Documentation Needs
Photo-documentation
Legal Use
Normal Anatomy and Innocent Findings
Pre-adolescent Hymenal Anatomy
Development Changes
Hymenal Opening Size
Bumps and Notches
Perihymenal or Periurethral Bands
Intravaginal Findings
Vascularity
Other Vaginal Findings
Anal Findings
Appearance of Injuries Associated with Sexual Assault
Summary of Post-traumatic Changes Associated with Penetrating Sexual Assault
FORENSIC CONSIDERATIONS
Trace Evidence and Evidence of Ejaculation
Interpretation of Forensic Evidence
Presence of Semen
Assailant Identification
THE ABUSED ADOLESCENT
Identity Formation in Adolescence
Treating the Sexually Abused Adolescent
GENERAL PRINCIPLES FOR WORKING WITH TEENAGERS SEXUALLY ABUSED
CHAPTER 2:
Violence against Children
INTRODUCTION
DEFINITION
GLOBAL PROBLEM
Settings in which Violence Occurs
Hidden Dimensions
Risk Factors and Protective Factors
THE DEVASTATING IMPACT OF VIOLENCE
IMMEDIATE AND LONG-TERM CONSEQUENCES OF VIOLENCE AGAINST CHILDREN
Physical Health Consequences
Sexual and Reproductive Consequences
Psychological Consequences
Longer-term Consequences
Financial Consequences
OVERALL RECOMMENDATIONS
CHAPTER 3:
Sexual Abuse in Children
INTRODUCTION
PRESENTING MANIFESTATIONS
Sexual Assault Protocols
Behavioral Indicators
Medical Indicators of Sexual Abuse
History from the Child
PHYSICAL EXAMINATION
LABORATORY DATA
DIAGNOSTIC CONSIDERATIONS
TREATMENT
Protecting Children from Sexual Abuse
LEGAL ISSUES
CHAPTER 4:
Female Circumcision
INTRODUCTION
FEMALE CIRCUMCISION
FEMALE GENITAL CUTTING
PREVALENCE
RELIGIOUS VIEWS ON FEMALE GENITAL CUTTING
FOUR TYPES OF FGM
PROCEDURES: WORLD HEALTH ORGANIZATION CATEGORIZATION
Type I
Type II
Type III: Infibulation with Excision
Type IV: Other Types
MEDICAL CONSEQUENCES
Complications are Common and Can Lead to Death
Immediate Physical Problems
Immediate FGM-Related Complications in Four Kenyan Districts (Fig. 4.3)
Long-Term Complications
SEXUAL CONSEQUENCES
ATTEMPTS TO END THE PRACTICE OF FGC
LAWS AND PREVALENCE
Africa
Burkina Faso (71.6% prevalence, Type II)
Central African Republic (43.4% prevalence, Types I and II)
Côte d’Ivoire (44.5% prevalence, Type II)
Djibouti (90–98% prevalence, Type II)
Ethiopia
Egypt (78–97% prevalence, Types I, II and III)
Eritrea (90–95% prevalence, Types I, II and III)
Ghana (9–15% prevalence, Types I,II and III)
Guinea (98.6% prevalence, Types I, II and III)
Nigeria (25.1% prevalence, Types I, II and III)
Senegal (5–20% prevalence, Types II and III)
Sudan (91% prevalence, Types I,II and III)
Tanzania (17.6% prevalence, Types II and III)
Togo (12% prevalence, Type II)
Uganda (<5% prevalence, Types I and II)
Asia
Indonesia (Types I and IV)
Lebanon
Australia
Canada
Italy
New Zealand
Sweden
United Kingdom
United States
More Women are Using Medical Staff, But Traditional Practitioners are Still Active
Attitudes are Gradually Changing
GLOBAL EFFORTS TO STOP FGM
Programs
Human Rights Efforts
The US Congress Legislation Against FGM
CHAPTER 5:
Shaken Baby Syndrome
DEFINITION
HISTORICAL ISSUES
VICTIM OF INTENTIONAL SHAKING CAN BE PROCEEDED WITH EXAMINATION KEEPING IN MIND THE FOLLOWING
Spontaneous Subdural Hemorrhage (SDH) Does Not Occur in a Normal, Healthy Infant
SDH Associated with Retinal Hemorrhage (RH) is a Pointer to “Non-Accidental Injury” (NAI)
IN THE ABSENCE OF EVIDENCE OF IDENTIFIABLE EXTERNAL TRAUMA, SDH AND RH ARE ONLY CAUSED BY VIOLENT “ACCELERATION/DECELERATION” ACTIONS CAUSED BY AN ADULT, KNOWN AS “SHAKEN BABY SYNDROME”
SBS Must be Intentional, or at Least Appear Intentional to any Dispassionate Observer
SYMPTOMS AND SIGNS
ANATOMY AND PATHOPHYSIOLOGY
MECHANISM
PREVENTION
DIAGNOSIS
TREATMENT
PROGNOSIS
EPIDEMIOLOGY
RISK FACTORS
LEGAL ISSUES
CONTROVERSIES AND ALTERNATIVE HYPOTHESES
Vitamin C Deficiency
Gestational Problems
Diffuse Injury
Force
BATTERED BABY SYNDROME
Definition
Causes and Symptoms
Description
Diagnosis
Prognosis
Treatment
Prevention
CHAPTER 6:
Juvenile Delinquency
INTRODUCTION
MALE PHENOMENON
MENTAL DISORDERS
INDIVIDUAL RISK FACTORS
FAMILY ENVIRONMENT
STRAIN
DELINQUENCY PREVENTION
SOCIAL CONSEQUENCES
CHAPTER 7:
Sudden Infant Death Syndrome
INTRODUCTION
NOMENCLATURE
HISTORY
CAUSES
RISK FACTORS
COPING
PREVENTION
INFANTICIDE IN TAMIL NADU: TWIN GIRLS KILLED
CHAPTER 8:
Consumer Problems and the Pediatrician
INTRODUCTION
WHO IS A PEDIATRICIAN?
WHO IS A CONSUMER?
IS CHILD A CONSUMER?
MEDICOLEGAL ISSUES AND PEDIATRICIAN
MEDICAL ERRORS
CROSSPATHY AND PEDIATRICIAN
ETHICAL ISSUES
RELATED ISSUES
ROLE OF IAP
ROLE OF COMMUNITY
JURISDICTION OF FORUM
ROLE OF JUDICIARY
ROLE OF GOVERNMENT
DO'S AND DON'TS
PART 2: GENERAL/MISCELLANOUS PEDIATRICS
CHAPTER 9:
Pediatric Liver Transplantation
INTRODUCTION
INDICATIONS FOR LIVER TRANSPLANTATION IN CHILDREN
LIVER TRANSPLANTATION IN CHRONIC LIVER FAILURE
Cholestatic Liver Disease
Metabolic Liver Disease
Chronic Hepatitis
Cryptogenic Cirrhosis
Fibropolycystic Liver Disease
Primary Immunodeficiency
CRITERIA FOR LISTING FOR LIVER TRANSPLANTATION IN CHRONIC LIVER DISEASE
Timing of Transplant for Chronic Liver Failure
Laboratory Parameters
Clinical Parameters
Scores Child Pugh (Table 9.2)
Pediatric End-Stage Liver Disease (PELD) Score
LIVER TRANSPLANTATION IN ACUTE LIVER FAILURE
LIVER TRANSPLANTATION IN INBORN ERRORS OF METABOLISM
LIVER TRANSPLANTATION IN HEPATIC TUMORS (TABLE 9.6)
CONTRAINDICATIONS FOR LIVER TRANSPLANT
PRETRANSPLANT EVALUATION
PREPARATIONS FOR LIVER TRANSPLANTATION
Immunizations
Management of Hepatic Complications
Nutritional Support
Psychological Preparation
LIVER TRANSPLANT SURGERY
Immunosuppression
POSTOPERATIVE COMPLICATIONS
A. Early Postoperative/Posttransplant Complications (Table 9.8)
B. Late Posttransplant/Postoperative Complications
LIVER TRANSPLANTATION SCENARIO IN INDIA
Author's Experience
OUTCOME
QUALITY OF LIFE
SUMMARY
CHAPTER 10:
Rickets: A Growing Concern
INTRODUCTION
DEFINITION
PATHOPHYSIOLOGY
Role of Vitamin D
WHAT ARE THE CLINICAL VARIANTS OF RICKETS?
HOW TO IDENTIFY RICKETS?
HOW TO DIAGNOSE RICKETS?
Radiological Findings7
Biochemical Findings8
Nonspecific Findings of Vitamin D Deficiency
WHAT CAUSES VITAMIN D DEFICIENCY?
Breastfeeding and Vitamin D
NUTRITIONAL RICKETS: IS IT DUE TO VITAMIN D OR CALCIUM DEFICIENCY?
Vitamin D Deficiency
Dietary Calcium Deficiency
HOW TO MANAGE VITAMIN D DEFICIENCY RICKETS (VITAMIN D RESPONSIVE RICKETS)?
HOW TO APPROACH A CASE OF RESISTANCE TO VITAMIN D?
WHAT ARE THE CHARACTERISTIC FEATURES AND MANAGEMENT OF DIFFERENT VARIANTS OF RICKETS?56
Vitamin D Malabsorption
Liver Failure
Vitamin D Dependent Rickets Type I
Vitamin D Dependent Rickets Type II
X-linked Hypophosphatemic Rickets (Vitamin D Resistant Rickets)
Renal Rickets
WHAT ARE THE DIFFERENT PREPARATIONS OF VITAMIN D AVAILABLE IN INDIA?57
CHAPTER 11:
Nutritional Anemia
INTRODUCTION
NORMAL AND SUBNORMAL HEMOGLOBIN LEVELS
IRON DEFICIENCY ANEMIA
Prevalence
Anemia and Malnutrition
Iron Metabolism18
Causes of Iron Deficiency19
a. Inadequate Iron Intake
b. Increased Demand
c. Abnormal Iron Uptake from Alimentary Tract
d. Blood Loss
e. Defective Plasma Iron Transport19
f. Erythropoietin and Iron Deficiency
g. Anemia of Chronic Inflammation
Consequences of Iron Deficiency Manifestations
Iron and Cognition
Febrile Seizures and Iron Deficiency
Effects of Iron Deficiency on Immunity
Breath Holding Spells
Pica
Thrombosis
Restless Leg Syndrome36
Diagnosis of Iron Deficiency Anemia
Prevention
A. Dietary Improvement
Meal Patterns
B. Food Fortification
Fortified Foods for Young Children
C. Iron Supplementation
Type of Iron Salt
D. Helminth Control
E. Iron Supplementation During Pregnancy38
Treatment
Dosage
Response to Iron Therapy41
Iron Sprinkles42
MEGALOBLASTIC ANEMIA (MA)
Is Prevalence of MA on the Rise?
Relative Prevalence of Deficiency B12/Folate
Etiology of MA/B12—Folate Deficiency
Clinicohematological Profile
Laboratory Findings
Diagnosis and Differential Diagnosis
Treatment
CHAPTER 12:
Thalassemia: Comorbidities
INTRODUCTION
THALASSEMIA AND IRON OVERLOAD
PATHOPHYSIOLOGY OF IRON OVERLOAD AND MECHANISM OF IRON TOXICITY
ENDOCRINE DISORDERS
Growth Retardation
Therapy
Delayed Puberty and Hypogonadism
Evaluation
Hypothyroidism
Impaired Carbohydrate Metabolism
Hypoparathyroidism
CARDIAC COMPLICATIONS
Pathogenesis of Heart Disease
Clinical Features
Evaluation
Management
Pulmonary Hypertension
LIVER IN THALASSEMIA
Hepatitis C
Diagnosis and Therapy1
Hepatitis B
Clinical Manifestations
Therapy Overview1
MRI EVALUATION OF IRON OVERLOAD
Osteoporosis
Evaluation
Management
INFECTIONS IN THALASSEMIA
Splenectomy
Iron Overload
Iron Chelators
SPECIFIC INFECTIONS
Parvo Virus B19
HIV
Cytomegalovirus
Yersinia Enterocolitica
Other Bacterial Pathogens
Malaria
COMORBIDITIES IN THALASSEMIA INTERMEDIA (TI)
HEPCIDIN AND IRON METABOLISM WITH REFERENCE TO THALASSEMIA
PSYCHOSOCIAL MORBIDITY
CHAPTER 13:
Interpretation of Peripheral Blood Film
INTRODUCTION
INITIAL WORKUP
RED CELLS
Morphologic Abnormalities
Anisocytosis and Poikilocytosis
Spherocytes
Elliptocytosis and Ovalocytosis
Irregularly Contracted Cells
Tear Drop Cells/Dacrocytes
Spiculated Cells
Echinocytes
Acanthocytes
Keratocytes
Schistocytes
OTHER FREQUENTLY ENCOUNTERED RED CELL ABNORMALITIES
Target Cells
Leptocytes
Stomatocytes
Sickle Cells
ALTERATION IN STAINING CHARACTERISTICS
Hypochromia
Anisochromasia
Dimorphic Picture
Hyperchromia
RED CELL INCLUSIONS
Basophilic Stippling
Heinz Bodies
Pappenheimer Bodies
Howell-Jolly Bodies
Hb-H Inclusions
CHANGES ASSOCIATED WITH COMPENSATORY INCREASE IN ERYTHROPOIESIS
Polychromasia
Normoblastemia
Red Cell Agglutination and Rouleaux Formation
RED CELL MORPHOLOGICAL ABNORMALITIES
LEUKOCYTES
Examination of a Blood Film
Brief Summary of Normal Maturation of WBCs
Leukocytosis
Physiologic Leukocytosis (Stress Hemogram)
Pathological Leukocytosis
Leukopenia
NEUTROPHILS
Neutrophilia
Increased Production
Increased Marrow Release
Defective Margination
Miscellaneous
NEUTROPENIA
DRUMSTICK (FIG. 13.24)
GRANULES AND INCLUSIONS
Abnormalities Associated with Nucleus
1. Hypersegmentation or Right Shift of Neutrophil Nuclei (Fig. 13.35)
Arneth index describes the nucleus of neutrophil
2. Pelger Huët Anomaly (Fig. 13.36)
3. Pseudo Pelger-Huët Anomaly
4. Auer Rods (Fig. 13.37)
LYMPHOCYTES
Normal Morphology of Lymphocytes
Morphological Variations in Lymphocytes
Eosinophila
Morphology (Figs 13.50 and 13.51)
Morphological Variation (Fig. 13.52)
MONOCYTES
Monocytosis
Monocytopenia
Morphology
Monocytes (Fig. 13.53)
Morphological Variations (Figs 13.54A and B)
BASOPHILS
Basophil (Figs 13.55 and 13.56)
THE PLATELETS
Thrombocytosis
Platelets
CHAPTER 14:
Interpretation of Bone Marrow Aspiration and Biopsy
INTRODUCTION
LANDMARKS IN BONE MARROW DIAGNOSIS
INDICATIONS OF BONE MARROW EXAMINATION
SPECIFIC INDICATIONS OF BONE MARROW BIOPSY
PROCEDURE FOR BONE MARROW ASPIRATION AND BIOPSY
Preferred Sites
Procedure
BONE MARROW ASPIRATION AND BIOPSY NEEDLES
BONE MARROW ASPIRATION FILM
BONE MARROW EVALUATION
BONE MARROW INTERPRETATION: THE PROTOCOL
A. Patient Information
B. Peripheral Blood Film Examination
C. Reporting of a Bone Marrow Aspirate
Hypercellular Marrow
Abnormalities in Number
Abnormalities in Maturation
Abnormalities in Morphology
Abnormalities in Maturation and Morphology
ABNORMALITIES IN MATURATION AND MORPHOLOGY
CYTOCHEMICAL STAINS
Uses
HEMOSIDERIN
BONE MARROW BIOPSY INTERPRETATION
Analysis of the BM biopsy
High Power Examination
Normal Distribution (Fig. 14.31)
QUANTIFICATION OF BONE MARROW RETICULIN
Causes of Increased Reticulin (Fig. 14.44)
BONE MARROW ARTIFACTS
Bone Marrow Aspirate Artifacts
Bone Marrow Biopsy Artifacts
SPECIAL TESTS ON BONE MARROW
Immunophenotyping
Techniques Utilized
CYTOGENETICS
Applications
CHAPTER 15:
Antioxidants in Clinical Practice
INTRODUCTION
SOURCES OF FREE RADICALS
FORMATION OF FREE RADICALS
MECHANISM OF CELLULAR DAMAGE2
ANTIOXIDANT DEFENCE
ANTIOXIDANTS SYSTEMS IN OUR BODY
Enzymatic AO
Preventive Antioxidants
Scavenger (Chain-breaking) Antioxidants
Dietary Antioxidants
Carotenoids
Vitamin C
Vitamin E
Selenium
Plant Antioxidants
Soy Isoflavones
Tea Polyphenols
ANTIOXIDANTS IN DISEASES
Retinopathy of Prematurity (ROP)
Bronchopulmonary Dysplasia (BPD)
Neonatal Necrotizing Enterocolitis
Wilson's Disease
Cholestatic Liver Disease
Pancreatitis
Kwashiorkor
Atherosclerosis
Juvenile Diabetes Mellitus
Drug Metabolism
Homozygous β Thalassemia
Hypoxic-Ischemic Encephalopathy (HIE)
Low Birth Weight Newborns
Patent Ductus Arteriosus (PDA)
SUMMARY AND CONCLUSION
CHAPTER 16:
Benign Epilepsies of Childhood
INTRODUCTION
CLASSIFICATION
BENIGN FAMILIAL NEONATAL SEIZURES (BFNS)
Clinical Characteristics
Genetics
Electroencephalogram
Treatment
Prognosis
BENIGN IDIOPATHIC NEONATAL SEIZURES
Clinical Characteristics
Etiology
Electroencephalogram
Prognosis
Treatment
Differential Diagnosis
BENIGN MYOCLONIC EPILEPSY OF INFANCY (BMEI)
Clinical Characteristics
Electroencephalogram
Prognosis
Treatment
Differential Diagnosis
SYNDROMES OF BENIGN INFANTILE CONVULSIONS
Clinical Characteristics
Prognosis
Genetics
Electroencephalogram
Clinical Characteristics
Treatment
Prognosis
Electroencephalogram
CHILDHOOD ABSENCE EPILEPSY (CAE)
Clinical Characteristics
Electroencephalogram
Prognosis
Differential Diagnosis
Treatment
JUVENILE ABSENCE EPILEPSY (JAE)
Clinical Characteristics
Electroencephalogram
Treatment and Prognosis
BENIGN PARTIAL EPILEPSY WITH CENTROTEMPORAL SPIKES/BENIGN EPILEPSY OF CHILDHOOD WITH ROLANDIC SPIKES (BECRS)
Clinical Characteristics
Electroencephalogram
Treatment and Prognosis
BENIGN PARTIAL EPILEPSY WITH OCCIPITAL SPIKES
Clinical Characteristics
Electroencephalogram
Treatment and Prognosis
Differential Diagnosis
Clinical Characteristics
Differential Diagnosis
Electroencephalogram
Treatment and Prognosis
BENIGN EPILEPSY OF CHILDHOOD WITH AFFECTIVE SEIZURES
BENIGN CHILDHOOD PARTIAL SEIZURES WITH FRONTAL SPIKES (BFE)
CONCLUSION
CHAPTER 17:
Status Epilepticus
INTRODUCTION
EPIDEMIOLOGY
CLASSIFICATION
Generalized Status Epilepticus
Focal Status Epilepticus
PATHOPHYSIOLOGY
CLINICAL CHARACTERISTICS
MANAGEMENT
a. Support of Airway, Breathing and Circulation (ABC)
b. Initial Termination of Seizure and Seizure Prevention
BPNA Status Epilepticus Working Group Guidelines7,38
c. Identification and Treatment of Associated Complications and Causal or Precipitating Factors
Indications for Emergency EEG
Predictors of Risk of Status Epilepticus
PREDICTORS OF OUTCOME IN STATUS EPILEPTICUS
MORTALITY
CHAPTER 18:
Refractory Epilepsy
INTRODUCTION
ZERO SEIZURES MAY NOT BE THE FINAL GOAL IN ALL TYPES OF EPILEPSIES
WHAT IS OPTIMAL TREATMENT?
WHAT ARE CONVENTIONAL MEDICATIONS?
WHAT ARE THE KNOWN ASSOCIATIONS OF REFRACTORY EPILEPSIES IN CHILDREN?
DOES THE NUMBER OF SEIZURES BEFORE TREATMENT INFLUENCE EASE OF CONTROL OR REMISSION OF CHILDHOOD EPILEPSY?
WHAT ARE THE COMMON RISK FACTORS THAT DICTATE THE PROBABILITY OF REFRACTORY EPILEPSY?
SURGERY FOR REFRACTORY EPILEPSY – HOW USEFUL IS THIS?
ROLE OF KETOGENIC DIET IN REFRACTORY EPILEPSY
VAGUS NERVE STIMULATION FOR CHILDREN WITH REFRACTORY EPILEPSY
GENETICS OF REFRACTORY EPILEPSY
HOW DO WE IMPROVE ON TREATMENT OF REFRACTORY EPILEPSY IN THE FUTURE?
CHAPTER 19:
Autism Spectrum Disorders
INTRODUCTION
EPIDEMIOLOGY
ETIOLOGY
Genetics
Environmental Factors
“Secondary” Autism Spectrum Disorders
NEUROPATHOLOGY AND NEUROIMAGING
ELECTROPHYSIOLOGY
CLINICAL PRESENTATION
Impairment in Social Interaction
Communication Deficits
Restricted Repetitive and Stereotyped Patterns of Behavior, Interests and Activities
Regression
COEXISTING CONDITIONS
Cognitive Abnormalities
Sensory-motor Integration Issues
Seizures
Other Coexisting Conditions
IDENTIFICATION OF ASDS
DIAGNOSTIC EVALUATION PROCESS AND TOOLS
LABORATORY AND OTHER MEDICAL WORKUP
TREATMENT
Behavioral and Educational Interventions
Applied Behavior Analysis (ABA)
Structured Teaching
Developmental Models
Psychopharmacological Treatment
Complementary and Alternative Medicine (CAM)
COURSE AND PROGNOSIS
CHAPTER 20:
Treatment of Fungal Infections
INTRODUCTION
CLASSIFICATION
ANTIBIOTICS
A. Polyenes
Amphotericin B
Mechanism of Action
Spectrum
Dose
Adverse Effects
Pharmacokinetics
Interactions
Nystatin
Hamycin
Natamycin
Heterocylic Benzofu
Griseofulvin
Mechanism of Action
Pharmacokinetics
Adverse effects
Use
Interactions
ANTIMETABOLITES
5-Flucytosine
Mechanism of Action
Adverse Effects
Pharmacokinetics
Dose
AZOLES
Imidazoles
Systemic
Dose
Adverse Effects
Drug Interactions
b. Fluconazole
Adverse Effects
Therapeutic Uses
c. Itraconazole
Adverse Effects
Drug Interactions
Uses
d. Voriconazole
Adverse Effects
Dose
e. Ravuconazole
f. Posaconazole
g. BAL-8557
ECHINOCANDINS
a. Caspofungin
Dose
Adverse Effects
b. Micafungin
c. Anidulafungin
d. Aminocandin (HMR3270)
TERBINAFINE
OTHER TOPICAL ANTIFUNGAL
a. Tolnaftate
b. Ciclopirox Olamine
c. Undecylenic Acid
d. Benzoic Acid
e. Quiniodochlor
CHAPTER 21:
Colony Stimulating Factors
INTRODUCTION
CLINICAL INDICATIONS
ASCO Guideline for the Use of G-CSF Following Chemotherapy
Exclusions
Primary Prophylaxis (i.e. Use with First Cycle of Chemotherapy)
Secondary Prophylaxis (i.e. Use after Episode of Febrile Neutropenia in Preceding Cycle)
In Established Febrile Neutropenia
CLINICAL TRIAL PATIENTS
Progenitor Cell Mobilization
Bone Marrow Transplantation
Severe Chronic Neutropenia
Patients Undergoing Peripheral Blood Progenitor Cell (PBPC) Collection and Therapy
Recommendation in Specific Settings10
Choice and Dose of G-CSF
Duration and Timing of G-CSF
CHAPTER 22:
Reactive Arthritis
INTRODUCTION
PATHOPHYSIOLOGY
CLINICAL PROFILE
Urethritis
Manifestations of the Urogenital System
Ocular Manifestations28
Arthritis
Cutaneous Involvement
Mucosal Lesions
Reactive Arthritis in Association with HIV Infection19,32
Etiology
DIFFERENTIAL DIAGNOSIS
Other Problems to be Considered
Post-streptococcal Reactive Arthritis (PSReA)
WORK-UP
Laboratory Findings
Radiological Findings
TREATMENT
Medical Management
Antibiotics36,37
Minocycline, Doxycycline
Azithromycin
Cefdinir
Vitamins
Calcipotriene
Nonsteroidal Anti-inflammatory Drugs38–40
Corticosteroids
Disease-modifying Antirheumatic Drugs (DMARDs)
Antineoplastic Agents
Antimalarials39–41
Retinoids
FOLLOW-UP
CHAPTER 23:
Prenatal Diagnosis
INTRODUCTION
INDICATIONS FOR PRENATAL DIAGNOSIS
1. Advanced Maternal Age
2. Previous Child with Chromosomal Abnormality
3. Fetus is High Risk for Single Gene Disorder
4. Abnormal Ultrasound Findings
5. Positive Maternal Serum Screen
6. Balanced Chromosomal Rearrangements in Parents
PRENATAL DIAGNOSTIC TECHNIQUES
Imaging Techniques
Amniocentesis
Chorionic Villus Sampling (CVS)
Cordocentesis (Percutaneous Umbilical Blood Sampling—PUBS)
Fetoscopy and Fetal Tissue Sampling23
Fetal Cells and Naked Fetal DNA in Maternal Circulation24
GENETIC AND MOLECULAR TECHNIQUES IN PRENATAL DIAGNOSIS
Conventional Methods
DNA Based (Molecular) Diagnosis31
Enzyme Assay
Rapid Analysis of the Chromosomal Aneuploidy33
RECENT DEVELOPMENTS
CHAPTER 24:
Neonatal and Pediatric HIV
INTRODUCTION
EPIDEMIOLOGY
Global Scenario1
Indian Scenario
Modes of Transmission
PATHOGENESIS
NATURAL HISTORY OF THE DISEASE
1. Rapid Progressors
2. Short-term Progressors
3. Long-term Progressors
CLINICAL FEATURES
COMMON OPPORTUNISTIC INFECTIONS (OI) IN HIV INFECTED CHILDREN
Bacterial Infections
Mycobacterial Infection
Viral Infections
Fungal Infections
Pneumocystis Jiroveci Pneumonia (PCP)
Other Fungal Infections
Parasitic Infestations
Toxoplasmosis
Other Parasitic Infection
ORGAN DYSFUNCTIONS IN HIV
HIV Encephalopathy
HIV Cardiomyopathy
HIV Nephropathy
Gastrointestinal Manifestations
Respiratory Disease
Hematological Manifestations
Dermatological Manifestations
Malignancies
Thrombosis
Other Organ Related Dysfunctions
LABORATORY DIAGNOSIS
Diagnosis of HIV in Infants
Diagnosis of HIV in Children Above 18 Months of Age
TREATMENT
MONITORING OF HIV INFECTED CHILD
COUNSELING
ANTIRETROVIRAL (ARV) DRUG THERAPY
Dosage
Guidelines for Starting ARV and Monitoring
Adverse Effects
Immunization
PREVENTION
Prevention of Mother/Parent to Child Transmission (MTCT/PTCT)
CONCLUSION
ACKNOWLEDGMENTS1
CHAPTER 25:
Antenatal Steroids
INTRODUCTION
MECHANISM OF STEROID-INDUCED LUNG MATURATION
TIMING OF STEROID ADMINISTRATION AND DOSE
HYDROCORTISONE, BETAMETHASONE OR DEXAMETHASONE
ANTENATAL STEROIDS FOR OTHER PREMATURITY-RELATED COMPLICATIONS
ADVERSE EFFECTS IN THE NEONATE
ADVERSE EFFECTS IN THE MOTHER
SUMMARY
CONCLUSION
CHAPTER 26:
Neonatal Sepsis
INTRODUCTION
DEFINITIONS4–6
INCIDENCE
PATHOGENESIS
PATHOPHYSIOLOGY12, 13
DIAGNOSIS
DIAGNOSTIC MARKERS
Definitive, Specific Diagnostic Laboratory Tests
Blood Culture
Cerebrospinal Examination and Culture
Adjunctive Nonspecific Diagnostic Tests
White Blood Cell Count
C-reactive Protein (CRP)
The Micro ESR
Sepsis Screen
MANAGEMENT
Recent Advances in Diagnosis and Management
CONCLUSIONS
CHAPTER 27:
Rheumatic Fever
INTRODUCTION
EPIDEMIOLOGY
ETIOPATHOGENESIS
PATHOLOGY
CLINICAL FEATURES
CARDITIS
Role of Echocardiography
Minor Manifestations
Laboratory Findings
Diagnosis of Streptococcal Infection
Treatment
PREVENTION OF RHEUMATIC FEVER
CHAPTER 28:
Immunization Programs in Developing Countries
INTRODUCTION
PROGRAM OVERVIEW
IMMUNIZATION PROGRAM MANAGEMENT
VACCINE PROCUREMENT, SUPPLY AND COLD CHAIN
IMMUNIZATION SERVICE DELIVERY
AEFI AND DISEASE SURVEILLANCE
IMMUNIZATION PROGRAM MONITORING AND EVALUATION
COST OF THE IMMUNIZATION PROGRAMS
INTERNATIONAL COOPERATION
CONCLUSIONS
CHAPTER 29:
Child Friendly School Initiative
INTRODUCTION
UNMET NEEDS IN SCHOOLS
THE STARTING POINT
WHAT MAKES A CHILD FRIENDLY LEARNING ENVIRONMENT?
THE GLOBAL SCENARIO
CFSI IN INDIA
KOCHI EXPERIENCE: KOCHI TO BE DECLARED FIRST CHILD FRIENDLY SCHOOL CITY
PERCEIVED BARRIERS IN IMPLEMENTING CFSI
THE WAY AHEAD
CHAPTER 30:
Integrated Management of Neonatal and Childhood Illness (IMNCI) Revisited
INTRODUCTION
BACKGROUND
Combination of Various Health Programs
Decrease in IMR: Unequal in Different States
Postnatal Care: Need for Improvement
Childhood Mortality
Global Scenario
Indian Scenario
Need for New Strategies
THE IMNCI PACKAGE
COMPONENTS OF IMNCI
1. Training
2. Improvements to the Health System
3. Improvement of Family and Community Practices
4. Collaboration/coordination with other Departments, PRIs, Self-help Groups, MSS, etc.
PRINCIPLES OF IMNCI
RATIONALE FOR AN INTEGRATED EVIDENCE-BASED SYNDROMIC APPROACH TO CASE MANAGEMENT
THE IMNCI ALGORITHMS5,6
IMNCI under RCH II (Fig. 30.2):
The IMNCI-Plus Approach (Table 30.1)
RCH II: Newborn and Child Health Package (Fig. 30.3)
CHAPTER 31:
Media and Children
INTRODUCTION
CHILDREN AND THE MEDIA: FACTS
HEALTH CONCERNS RELATED TO MEDIA USE
MEDIA AND THE FAMILY
PHYSICIAN RESPONSIBILITY TO ADDRESS MEDIA CONCERNS
CHAPTER 32:
Common Sleep Disorders
INTRODUCTION
DURATION OF SLEEP
FACTORS AFFECTING SLEEP SCHEDULE
DIAGNOSTIC PROCEDURES IN SLEEP PROBLEM PATIENT
Sleep Logs
Actigraphy
Polysomnography
SLEEP DISORDERS
Insomnia
Hypersomnia
Circadian Rhythm Sleep Disorder
Nightmares
REM-Sleep Behavior Disorder
Confusional Arousals
Sleep Walking
Sleep Terrors
SleepTalking
Narcolepsy
Restless Leg Syndrome
Bruxism
Sleep-related Rhythmic Movement Disorder
Obstructive Sleep Apnea
SLEEP PROBLEMS IN HEADACHE PATIENTS
CHAPTER 33:
Primary Immunodeficiency: Genetic Basis
INTRODUCTION
RECOGNIZING IMMUNE DEFICIENCIES
EVALUATION FOR SUSPECTED IMMUNE DEFICIENCIES
DETERMINING DEFECTS IN CELLULAR IMMUNE RESPONSES
DETERMINE DEFECTS IN HUMORAL IMMUNE RESPONSES
DETERMINE DEFECTS IN PHAGOCYTE FUNCTION
DETERMINING DEFECTS IN THE COMPLEMENT IMMUNE SYSTEM
CATEGORIZATION OF PRIMARY IMMUNE DEFICIENCIES
DEFICIENCIES IN LYMPHOCYTE SIGNALING AND GROWTH FACTORS
DEFICIENCIES IN DEVELOPMENT AND SURVIVAL
DEFICIENCIES IN T AND B CELL INTERACTIONS
PHAGOCYTE DEFECTS
COMPLEMENT DEFECT
DISORDERS OF IMMUNE REGULATION
SUMMARY AND CONCLUSIONS
CHAPTER 34:
Respiratory Allergies: Therapeutic Trends
INTRODUCTION
ANTIHISTAMINES
Histamine H3 Antagonists
TOPICAL NASAL STEROIDS
LEUKOTRIENE ANTAGONISTS
IMMUNOTHERAPY
Mechanism of Immunotherapy
Subcutaneous Immunotherapy
Sublingual Immunotherapy (SLIT)
Intranasal Immunotherapy
Peptide Allergen Immunotherapy
HUMANIZED MONOCLONAL ANTIBODY
EXPERIMENTAL APPROACHES
SUMMARY AND CONCLUSION
INDEX
TOC
Index
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