पेशाब में इन्फेक्शन है खतरनाक

पेशाब में इन्फेक्शन है खतरनाक

यदि बुखार में पेशाब की जांच करायी जाए, तो हर १० बच्चे में तीन-चार बच्चों को पेशाब का इन्फेक्शन पाया जायेगा | यह अत्याधिक कॉमन है और एक दो दिन एंटीबायोटिक खिला देने के बाद भी सामान्यतः पेशाब की जांच नार्मल आती है, अतः यदि शारीरिक जांच में बुखार के कारणों का पता नहीं चलता है, तो तुरंत एंटीबायोटिक शुरू करने से पहले पेशाब की जांच करा ली जाती है, बिना पेशाब की जांच के एंटीबायोटिक दिए जाने पर 70-80 प्रतिशत मामलो में पेशाब का इन्फेक्शन ठीक हो जाता है, परन्तु यदि इन्फेक्शन का पता हो, तो उपयुक्त दावा, डोज को 7 दिनों तक देकर साधारण इन्फेक्शन को जड़ से ठीक किया जा सकता है, यदि रोग का सही से उपचार न हो पाये, तो इसके कारणों का पता नहीं चल पाटा है, यदि इन्फेक्शन खतरनाक रूप धारण कर ले, तो यह किडनी तक पहुच सकता है, इससे किडनी खराब भी हो सकती है, यदि इन्फेक्शन काम्प्लेक्स है, तो पेशाब की जांच के बाद किडनी यूरेटर एवं ब्लाडर का अल्ट्रासाउंड एवं बच्चों में M W G अवस्य करवा लेनी चाहिए, इससे रोगों का पता चलता है और किडनी को ख़राब होने से बचाया जा सकता है |

HLH:deadliest post vacination complications in 2 months old baby

Hemophagocytic lymphohistiocytosis:Few years ago 1  1/2 months old baby received vaccinations and then fever never dropped. Condition deteriorated with relentless fever more than 104 f with rapidly increasing liver and spleen.hemoglobin &platelet too dropped.all sorts of empirical antibiotics failed and at last was investigated for this deadly dis which came positive by these 5 criterias

1.hb less than 9 & platelet less than 1 lac.
2.Triglyceride more than 180

3.low fibrinogen. 

4.very high ferritin 16000.

5.fever more than 5 days WITH HSM.

The precipitating cause was immunodeficiency and cmv IgM was very high 140.

Without treatment the kid succumbed at 10months of age.

Even in excellence centre ohio childrenhospital.cincinnati

USA the youngest in their record with this disease was 2 1/2 months in 2012

Later father disclosed history of unexplained death of 2 Sibs in infancy in 2005 and 2006.

Even AIIMS AND PGI chandigarh  couldnt detect the underlying pathology in 2006.
Treatment of this genetic or disease  is by chemotherapy and is deadlier than most human cancers as untreated mostly die in 8 to 10 months after diagnosis.
Dr s kumar.child specialist.
Beside nifft gate. hatia.ranchi.jharkhand.
7250725044.7004780897.

Celiac disease in twin 1 yr sisters causing convulsions

1 yr twin sisters had repeated seizures in last 2 months .on anticonvulsant was controlled.ct scan.metabolic diseaese for 103 INBORN metabolic error by UCMS and TMS and all routine invest are normal except EEG having epileptic  discharges.
Later I got history of several very offensive stools oily and semiformed in both sisters so DGP Iga was done which came  normal.other antibodies are not done as will not come +ve in such young kids.so only way to confirm diagnosis is by HLA for celiac disease which was done and came +ve as expected .the important reports r attached here.
Seizures due to celiac disease is 1st reported in such young twin sisters perhaps in the world.
Hopefully the seizures will be controlled without any anti epileptic when total GFD is substituted in both Sibs.the stools improved much on GFD even before the confirm report was available.
Perhaps  it will be 1st case of seizures controlled by without any antiepileptic drugs.
So we should strive to search the basic cause of epilepsy so that on its control patients relieved from taking long term AED.
Dr s.kumar.child spEccleston.
Rainbow chIld hospital and clinic.
Beside NIFT gate.ranchi khunti highway.
Hatia.ranchi .jharkhand.
7250725044.7004780897.8581989590.

Malaria and Typhoid

मलेरिया व टाइफाइड

करीब डेढ़ साल पहले सात साल के एक लड़के को इलाज के लिए लाया गया, उसे २५ दिनों से १०५ डिग्री बुखार आ रहा था, २४ घंटे में दो बार अत्त्याधिक कपकपी आ रही थी. मैंने जांच किया तो बुखार उस समय १०४.८ डिग्री था, लीवर, स्प्लीन बढ़ा हुआ था | शरीर शिथिल व कमजोर अवस्था में था, उसने कई दिनों से खाया नहीं था, सिर्फ पानी पी रहा था, कुछ दवाइयां पहले से चल रही थी, लेकिन लाभ नहीं हो रहा था| २० दिन पहले की जांच रिपोर्ट उनके पास थी | सिर्फ टाइफाइड के लिए एंटीबायोटिक चल रहा था, टाइफाइड काफी गंभीर था, मैंने टाइफाइड के लिए एंटीबायोटिक इंजेक्शन दिया, मगर ६ -7 दिनों के बाद भी बुखार १०४ से कम नहीं हुआ, तब मुझे मलेरिया का भी शक हुआ, लैब में दुबारा जांच के लिए सैंपल भेजा, इस बार मलेरिया फेल्सिफेरम की पुष्टि हुई, तुरंत मरीज को बुलाया गया और Artesunate का इंजेक्शन दिया गया, तीन दिनों तक दावा देने क बाद भी बुखार नहीं उतरा, अतः इसे रेजिस्टेंट मलेरिया माना गया, कुनैन के नहीं मिलने पर मरीज को क्लिंडामाईसिन दिया गया, अगले 2 दिन में ही यानि १२ दिन के इलाज के बाद बुखार उतरना शुरू हो गया. २२-२३ इलाज होते होते बच्चे का बुखार उतर गया. १० दिन और एंटीबायोटिक दी गयी, जिससे लीवर और स्प्लीन नार्मल हो गया | इस तरह कुल ३५ दिन इलाज चलने के बाद बच्चा पूरी तरह से ठीक हो गया | उसके बाद बच्चे को टाइफाइड का वैक्सीन दिया गया, बच्चे को मलेरिया का टीका लगाने की भी सलाह दी गयी| 

hyperuricemia without nephrolithissis: surprising cause of abdomi pain in 10 yr old girl.

Hyperuricemia in 10 yr old girl: surprising cause of severe abdominal pain

This  perfectly normal healthy girl suffers of severe abdominal pain for last 6 yrs during the month of april to june.associated with vomitings and loose stools during initial days .the pain lasts for 4 to 5 days and makes her bed ridden.she is not able to move at all due to intense generalised cramping abdominal pain.by rx for AGE as usually understood by doctors she anyhow improves within a week and remains symptomfree for whole year .this yr last month in june she suffered similarly and was admitted under me.inspite of my best anti spasmodic rx the abdominal pain didt subisde even a bit.all investigations  came -ve as written below
1.cbc : twice done wbc 16000 & 20000.n above 70 %.hb 13.11000 after rx and improvement.
2.esr 35 and 18( after rx.)
3.sickling -ve4.thyroid normal
5.na k cr normal.
6.ca 8.2.
7.sgpt 51. Albumin 3.1.globulin 3.4.
9.anti ttg iga 7.2.iga 2.
10.anti ama.sma.ana.p & c anca.asca antibodies normal.
11.elisa for hook worm and echinoccus  normal
12.ur rm & c/s normal.
13 igg.igm normal.
14.ige 1700.
15.uric acid 7.6
16.allergic profile report is awaited.
17.xray .us & ct abdomen normal.
18.urine for porphobilinogen normal
19.abg respiratory alkolosis as she was hyperventilating due to pain.
20 blood sugar several times normal.
inspite of best antispasmodics.antibiotics and others pain didnt relieve for 1 week.she didnt pass stool even during the period.oral intake was very poor.
only favourable cond was her vitals remained stable and didnt deteriorate.
the day febuxostat for hyperuricemia was added her pain gradually began to reduce and in 3 to 4 days pain completey subsided and was thus discharged on it.
so its very suprising to conclude hyeruricemia without nephrolithiasis as cause of severe abdominal pain.its probably first treated case in the world as no article supporting hyperuricemia per se as cause of abdominal pain has been described or propounded.
its a matter of research and work up.
by dr s kumar.child specialist.
rainbow child clinic & hosp.beside nifft gate.hatia.
ranchi khunti highway.ranchi.jh
7250725044.7004780897.8581989590

severe anxiety neurosis in 5 and 10 yr old kid

Few yrs back a 5 year boy consulted me for extereme inconsolable crying and screaming usually in night to wake up the whole building since he was infant almost every 3rd -4th night .He complained of severe excruciating pain at a particular spot in his limb which changed in each such screaming episodes.once he was brought as emergency from nearby movie hall in the evening .while talking to parents another child entered my clinic screaming due to abdominal pain and while injecting this child antispasmodic and pain killer the 1st child ceased screaming and got up to have a clear view of process of injecting the other child in pleasant mood.thus it proved the 1st child was suffering of some anxiety neurosis which parents hardly believed.prior to this episode all invest including bone scan was normal.some anxiolytic and counselling of the child completely cured the condition and child is well for last 2 yrs..

Menace of hyperuricemia
Excruciating pain in ankles.hallux and any other site is commonest presentation of hyperuricemia.
It has been seen to present in my experience as
1.a 36yr old lady had uric  acid of only 5.6 and her problem of pain in legs.knees and then generalised further aggravated and after 2 to 3 mnths facial edema and pedal edema appeared .she didnt get relief on any rx by various doctors and at last consulted me.i opined in her case uric acid shld be normally below4 insted of 7 and thus febuxostat was instituted .for 10 days her edema and pain didnt respond but patiently it was advised to continue.after 2 wks some relief was felt and thus same rx was continued for more than  1mnth till she became asymptomatic and her uric acid brought below 4 which I feel should be considered upper  normal in such patients.
2.in my 8 yr old son uric acid was just 4.9 but he had such excriciating sole pain that he barely walked.he was too treated in same way to reduce its level below 3.5.
3.a young poor lady had severe intolerable giddiness and straight away slept in  my clinic even on floor as she couldnt balance to sit even.all sorts of rx for vertigo was tried but none worked.at last uric acid was found 6.9 and its rx continously for 10 days reduced giddiness by 25% and thus same rx for 1 1/2  mnth completely subsided the symptoms and thus she became normal.she has taken several rx for it by at least 7 doctors before she consulted me.
thanks
dr s kumar.