മാഷ്

താഴെ കൊടുത്തിട്ടുള്ള ഫോട്ടോകൾ പല കുട്ടികളുടെ ആണ്.  പലപ്പോഴായി എടുത്തിട്ടുള്ളവ. പല പ്രായത്തിലുള്ള കുട്ടികളുടെ. ഇതിൽ മൂന്നു മാസം പ്രായമുള്ളവനുണ്ട്.ഏറ്റവുമൊടുവിൽ വന്നയാൾക്കു ഒൻപതു മാസം ആണ് പ്രായം. എല്ലാവര്ക്കും പൊതുവായുള്ള കാര്യം ഒരു മുഴയാണ്. പലർക്കും അത് കക്ഷത്തിൽ ആണ്.ചിലർക്ക് തോളെല്ലിന് മേലെ,ചിലർക്ക് തോളെല്ലിന് താഴെ. ഇത് രണ്ടും അല്ലാതെ ബി സി ജി എടുത്ത ഭാഗം പാണപ്പഴം പോലെ മഞ്ഞനിറത്തിൽ പഴുപ്പ് കെട്ടിയ രീതിയിൽ. ഒരു കാര്യം പ്രത്യേകം എടുത്തു പറയണം. പഴുപ്പും കുരുവും ഒക്കെ വരുമ്പോൾ നമ്മൾ വേദന കൊണ്ട് പുളയും, പക്ഷെ അതൊന്നും ഇവർക്ക് ബാധകമേ അല്ല.  ഒന്ന് നോക്കാൻ കൂടി സമ്മതിക്കാതെ നമ്മളുടെ സ്റ്റെത്തും പേനയും പിടിച്ചു വലിച്ചു കളിയും ബഹളവും. ഇങ്ങനെ ഒരു കാര്യം മൂപ്പർക്ക് പുല്ലു വില.നമ്മൾ അതൊന്നു തൊട്ടാലും ഞെക്കിയാലും ഒന്നും കാര്യമായ ബഹളവും കരച്ചിലും ഒന്നുമില്ല. എല്ലാരും പ്രായത്തിനനുസരിച്ചു തൂക്കമുണ്ട്,ബുദ്ധിവികാസത്തിനും ഒരു പ്രശ്നവും ഇല്ല , കുസൃതിക്കു ഒരു കുറവും ഇല്ല. ചിലരൊക്കെ ഒന്നും രണ്ടും മൂന്നും കോഴ്സ് മരുന്ന് കഴിച്ചവരാണ്. ഒന്ന് രണ്ടു പേര് ഇത് കുത്തിപരിശോധിച്ചു റ്റീബി...

One year old girl child normal growth and development started showing this head nodding and difficulty in sitting and standing . Mother attributes everything to a fall which happened 9 days back, fall while she was sitting and playing. She noticed this problem next day onward. (consent taken from parents for publishing this for teaching purpose) No significant illness in the past. No fever during the illness or immediate past No history of any drug intake (  Possibility of drug ingestion was thought of and excluded) Only child,born at term No significant perinatal illness, Development in all fields normal till now. No family history of any neurological illness On Examination Vitals stable. She was irritable disturbed by this unsteadiness and inability to hold neck and sit straight. No pallor No lymph node No neurocuaneous markes No rash Pulse 110/mt normal volume,. BP normal for age CNS  Head nodding and unsteadiness in sitting. Trunkal ataxia.Intention ...

5 month old girl child brought  with complaint of not achieving milestones. Sixth child of non consanguineous marriage  between 35 year old mother and 39 year old father. First baby conceived after treatment of infertility.Father,he had oligospermia. There were three abortions in the first trimester, first third and fourth. Second baby delivered normally,did nt thrive and died at  64 days of age  (poor sucking and activity,respiratory distress,procedure s/o peritoneal dialysis done,birth weight-2.3 kg, and weight at 64 days wt-1.3 kg). There is only one  normal living girl child,now 3 years old. No family history of early child death, in other members or developmental delay or significant neurological illness on both parent sides. Present child- During pregnancy  mother had gestational diabetes and,was on insulin.Diabetes was well controlled.Delivered at full term LSCS 2.7 kg.female baby cried immediately after birth.Breast...

First case  Previously health 12 year old boy, noticed swelling above his left ankle. Initially he was not disturbed with this as it was not painful and did nt limit his play and activities. Later he had minimal pain on brisk walking  and he observed swelling was gradually  increasing in size. He came to us three months after the onset. He did nt have  fever. No similar swelling anywhere else. He did nt have other symptoms like fatigue ,syncope bleeding manifestations. No family history of similar swelling on the body. On examination  Diffuse swelling on the medial aspect of lower limb, 4 X 4 cms. Surface normal ,there was no discoloration. No other swelling anywhere. No pallor  No lymph nodes. As the swelling was growing over the last three months we considered the possibility of malignancy.  We did a Plain X-Ray lower leg and foot AP and Lateral Differential diagnosis of lytic lesions of bone considered .   ...

Sharing thoughts about few cases we encountered this week. First one is a case of Hand foot mouth disease. Just to highlight few atypical features. This entity was not a common before 2000. when we encounter fever with vesicles. most common possibility we considered was varicella (chicken pox). Even though we studied theoretical details of smallpox,and how to differentiate this from chickenpox it was not of much practical use as it was declared eradicated in 1980. This new entity of HFMD appeared once in a while in the beginning of this century but last ten years this became more common than chickenpox . If we examine the data in IDSP Kerala,last year we ll see the number of chicken pox cases in thousands. Most of this must be wrongly reported HFMD, some times if we are not careful it is very likely that Hand foot mouth disease is mistaken for varicella and many cases put on anti viral drugs and contacts vaccinated against varicella. In a way it is good. One interesting thing ...

6 year old boy. 1st child of non consanguineous marriage , developmentally normal unimmunised with no significant past history now presented with c/o low grade fever since 6 days associated with throat pain on day 1 of illness. On day 2,was taken to hospital and was treated as Out patient  basis. On day 3, developed 5-6 episodes of vomiting. On day 4,mother noticed swelling side of neck , which was gradually increasing in size So he was hospitalised on same day and started with Iv Ceftriaxone. On day 5, fever decreased but vomiting persisted. Day 6, swelling increased over right side and minimal swelling over left side and was referred to here i/v/o suspecting diphtheria. At admission, child was conscious, sick looking, Pulse rate 90/mt, good volume,occasional irregularity. Respiratory rate 24/mt, afebrile, swelling side of neck below mandible and ears both sides. tonsillitis with greyish white membrane in tonsil and posterior pharyngeal wall with bleeding spots and ...

Hope NIPAH won't lead to any secondary case this time. This small write up is  not looking  things lightly,but analyzing the situation  comparing the previous years experience. This time  with early diagnosis containment,and awareness creation within such a short period was wonderful. Administration,  media and people from all walks of life  joined hands to achieve this comparatively relaxed state of affairs. This time no panic,awareness about the condition &need of precautions  reaching even to the layman and preparedness to tackle even the worst situation. Isolation and management facilities are set up in most of the major institutions. Calicut having the best experience taking the lead. In this context, sharing few thoughts/ dilemmas which most of us facing at this stage. Arrangements made in different institutions vary depending on the infrastructure manpower. But basic points considered will be same 1.Pick up the possible cases earl...