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Treatment of Child and Adolescent Problems
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Thyroid Disorder Treatment
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Treatment of Childhood Infections
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Management of New Born Care
Preimplantation Genetic Diagnosis (Pgd)
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Treatment of Polycystic Ovary Syndrome In Adolesce
Treatment of Thyroid Disease in Children
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Mucormycosis is a kind of fungal infection that falls under the category of mucorale family. Although rare, mucormycosis is a very serious condition. It occurs when the immune system has become weak as a result of a health condition or illness. Mucormycosis can prove to be fatal if left untreated.
Mucormycosis can arise on any part of the body. It initially appears at the site of injury or trauma on the skin and then spreads quickly to other places. Initial symptoms that indicate the possibility of mucormycosis include-
Mucormycosis and Pediatrics
Mucormycosis is one of the most common fungal infections to occur in children. Pediatric mucormycosis affects children already suffering from malignancies such as pulmonary, paranasal sinus, or disseminated disorders and is extremely lethal. A combination of surgery and active anti-fungal therapy provides a better outcome.
Usually, children suffering from mucormycosis do not realize it because the symptoms associated with it are also similar to many other disorders or illnesses. However, it is recommended that you take your child to visit a doctor if you suspect an infection.
The condition is diagnosed with the help of a nasal discharge or phlegm sample if you are suffering from a sinus infection. In case the infection has come about due to a skin infection, your health care provider might clean the area that is in question.
Treatment of Mucormycosis
- One of the first steps to treating mucormycosis is receiving anti-fungal infections through IV or intravenous. The next step that follows is surgical debridement which involves cutting away of the infected tissue. Removing away the infected part by cutting it away from the body prevents the chances of the infection from spreading to the other body parts.
- If the response rate of the patient is fairly well to intravenous and tissue removal method, the doctor will move onto the stage of oral medications in place of IV.
- As mucormycosis is not contagious, it is not likely to get passed onto from an already infected person. Therefore, this matter self-care measures are the only way to evade an infection. If your child has weak immunity, for example, ensure that he/she wears a mask while doing any activity that involves dust and inhaling any outside air that might be polluted. Taking precautions during any change of season is also recommended.
Renal Tubular Acidosis is a medical condition. When the kidney is unable to acidify urine, it leads to the accumulation of acid in the body. Usually, when blood is filtered by the kidney, it passes through the tubules of the nephrons (the functional unit of the kidney).
Before it flows into the bladder from the kidney, the urine undergoes an exchange of salts, acids and other solutes. Renal tubular acidosis results in the formation of excessive amounts of acid because the kidneys cannot drain them. This may happen because the kidneys cannot reabsorb the alkaline bicarbonate ions from the urine in the early segment of the nephron or because of inadequate production of acidic hydrogen ions in the latter half of the nephron.
• Distal Renal Tubular Acidosis (RTA)
This is the most fundamental form of RTA. It is characterized when the hydrogen ions are not secreted into the lumen of the nephron by the alpha-intercalated cells of the medullary collective duct of the distal nephron. When this happens the pH of urine cannot be brought down below 5.3. Renal excretion is inhibited and hydrogen ions are not eliminated which leads to academia. At the same time, Potassium ions cannot be absorbed by the cell which leads to hypokalemia. The end result is protein retention and potassium excretion. Distal RTA can lead to the urinary stone formation, calcium deposits in the kidney, rickets and osteomalacia and Sjogren’s syndrome.
• Proximal RTA
When proximal tubular cells reabsorb 85% of filtered bicarbonates and 60% of filtered sodium from the urine, then this again leads to academia. The distal intercalated cells, however, function normally and so the academia is not as severe as in case of Distal RTA. The alpha-intercalated cells can acidify urine to a pH of 5.3 or less because they produce hydrogen ions. Proximal RTA is also associated with Fanconi Syndrome which is characterized by aminoaciduria, uricosuria, glucosuria, and tubular proteinuria.
• Combined distal and proximal RTA
Inherited carbonic anhydrase II deficit leads to combined distal and proximal RTA. This is accompanied by osteopetrosis, cerebral calcification, and renal tubular acidosis. Cases of combined distal and proximal RTA are very rare.
How is RTA understood?
The following steps are applied to analyze Renal Tubular Acidosis-
• Determining the anion gap in acidosis. The normal Anion Gap is 8-12 (4-6 mEq/L)
• Separating the renal from the extrarenal causes of normal anion gap acidosis
• Classifying the types of RTA
• If it is distal RTA, further tests will be necessary to support the diagnosis
How is RTA diagnosed?
Three types of tests can reveal if a person is affected by Renal Tubular Acidosis-
• Urine test
• Acid load test
• Physical examination
Treatment of RTA-
Doctors prescribe either or both of the following two types of therapies-
• Alkali therapy- The pH level of urine is restored and electrolytes are balanced
• Vitamin D supplements- If RTA leads to bone deformities or rickets, your doctor will prescribe vitamin supplements to strengthen your bones.
Timely diagnosis can prevent the effects of Renal tubular Acidosis from becoming compounded. With the right medication, a person can lead a healthy normal life.
Kidneys are an important part of your body!
We have two kidneys. The kidneys are located on either side of the spine, just below the rib cage. Each kidney is about the size of your fist. The kidneys are shaped like "kidney beans". Your kidneys are connected to your bladder by tubes called ureters.
What Your Kidneys Do
- Make urinea
- Remove wastes and extra fluid from your blood
- Control your body's chemical balance
- Help control your blood pressure
- Help keep your bones healthy
- Help you make red blood cells
Can Child suffer from kidney diseases? How do we come to know about kidney diseases in your child?
Yes, childhood kidney diseases are common but often missed and diagnosed late. Parents can recognize and consult pediatric nephrologist if their child has any of the following condition -
Swelling around the eyes, face, feet, abdomen and whole body
Bedwetting (5 years or older) can be since birth or if the problem recurs after the child had stopped bedwetting for some time
Frequent urination during daytime and night time
Crying during urination (in infants)
Painful urination (in older kids)
Unexplained low-grade fever or recurrent fever episodes
Urine that is cloudy, bloody or dark brown or any color change
Persistent abdominal pain and rash
Childhood renal stones
Frequent severe headaches
Oliguria with diarrhea (producing less urine)
Polyuria (producing more than 2 litre urine/ day)
Poor appetite (in older children)
Poor eating habits, vomiting (in newborns & infants)
Slow growth or weight gain
Weak urinary stream, dribbling of urine stream
Weakness, excessive tiredness or loss of energy
Pale skin appearance
Abnormal bone health and poor growth.
Birth defect in kidney. (hydro-nephrosis, cysts)
Common childhood renal diseases are:
1. Urinary tract infections (UTI) are easy to diagnose in older children and adults but difficult in infants with vague symptoms. Symptoms include frequent, painful, burning urination, fever, and urine may appear cloudy or bloody. If infection reaches kidneys, back pain and high-grade fever may also occur. For UTI, a urine sample is taken to check for bacterial growth.
When urine goes back up from the bladder to the kidney then termed as reflux. It is often diagnosed after a child has a UTI or if a child without symptoms is diagnosed before or after his birth with congenital defect (persisting pelvis and ureteric dilatations).
2. Nephrotic Syndrome: Child present with sudden onset swelling over face, eyes and body and will have significant urinary protein. It can appear with or without upper respiratory tract infection symptoms. Diagnosis needs confirmation with the persistence of low albumin and high cholesterol levels in the blood investigations and documentation of high urinary protein. Although commonest affected age group is 3-4 year we also often see kids beyond this age group.
Kidney biopsy may be required here, depending on response to treatment.
3. Glomerulonephritis : Dark color urine (red color/ cola color) & swelling of the face, with or without accompanied rash, persisting fever need urgent admission, evaluation, and treatment. Most of time Kidney biopsy is needed here to know the underlying disease.
4. Acute kidney disease (AKI) lasts for a short time and be serious with long-lasting consequences or may go away completely once the underlying cause has been treated. Acute kidney disease may require dialysis therapy for a short duration. Parents should worry if recovery noticed.
5. Chronic kidney disease (CKD) does not go away with treatment and tends to get worse over time. CKD leads to end-stage kidney failure and requires renal replacement therapy i.e kidney transplant or blood-filtering treatments called dialysis.
Can child undergo dialysis and kidney transplantation?
Yes, not only in children, dialysis can be done in newborn. Two types of Dialysis are available, peritoneal and hemodialysis. Child with adequate weight can also undergo kidney transplantation if donor is matching. So parents should seek treatment of their child kidney disease.
Where should you consult?
All newborn and children having any kidney diseases need consultation with Pediatric Nephrologist.
The nephrotic syndrome refers to a kidney disease. Nephrotic syndrome is triggered when the glomeruli (tiny structures in the kidneys) malfunction or are damaged and allow too much protein to enter into the kidneys. Nephrotic syndrome is a chronic ailment but not very prevalent. In India, fewer than 1 million cases are reported every year.
Who is susceptible to Nephrotic Syndrome?
Children, especially between the ages 2-6 are vulnerable to coming down with this ailment. It is prevalent more amongst male children than female. Around 3-4 children out of 100,000 are affected by it. Age of onset determines how severe the syndrome will be.
What are the symptoms of Nephrotic Syndrome?
Nephrotic syndrome is characterized by swelling up of the face. The swelling spreads to other parts of the body. This is when most doctors will recommend a urine test to confirm if the child has contracted nephrotic syndrome.
Diagnosis of the disease-
Nephrotic syndrome can be diagnosed following procedures to test the presence of high cholesterol and low albumin levels in the blood. The doctor will also document the ratio of urinary protein to creatinine of more than 2 to confirm the diagnosis.
Nephrotic syndrome treatment-
The treatment options for the symptoms of nephrotic syndrome are as follows-
• If nephrotic syndrome is detected in children less than 3 months of age, they will only require albumin transfusion and diuretic medication. For older children, oral steroids are a trusted medication only after determining that there are no underlying diseases.
• Parental counseling is necessary so that they can understand the medicine dosage, duration and side effects of steroidal treatment. Parents need to purchase uristix that can reveal protein levels in urine. It is imperative that parents regularly monitor their child’s urine. This way, the syndrome does not become aggravated and the child does not need to be hospitalized.
Medication for nephrotic syndrome can be steroid sensitive or steroid insensitive.
• In the case of steroid-sensitive medicines, swelling keeps recurring frequently or infrequently. But it is not followed by an infection. These are called relapses that require other immunosuppressive drugs. Regular follow up is recommended.
• For steroid resistant medication, a kidney biopsy is mandated to understand the underlying cause of nephrotic syndrome. Based on the test results, the doctor initiates calcineurin inhibitor therapy. This procedure is performed by a pediatric nephrologist in children.
The dosage depends on the child’s weight. Inadequate or overdose can harm the child.
The side effects of steroids include-
Diet for nephrotic syndrome-
A proper diet can work wonders in controlling the symptoms of nephrotic syndrome. A doctor usually recommends cutting down on salt and advises minimum intake of fluids. Since cholesterol levels go up with this syndrome, a diet low in saturated fats is suggested. Even though nephrotic syndrome is accompanied by loss of proteins, a high protein diet is not recommended because proteins aggravate the syndrome.
When the underlying causes of nephrotic syndrome (other diseases that trigger it) are cured, the symptoms of nephrotic disorder dissipate. The proper diet and medication will ensure that a child outgrows the disease and lives a healthy life.