Wednesday, July 20, 2016

Common mistakes in Per Abdominal examination

1. Forgetting to Expose abdomen adequately:
Before examination, patient should ideally be exposed from nipples to mid thigh. Failure to do so may lead to missing findings during examination eg. Hernia



2. Abdominal symmetry and movement: Should be examined tangentially and from leg end. Comment should be made on movement of all quadrants with respiration.

3. Forgetting to relax abdomen before palpation:
Flex the legs at knees and arms should be by side of body. Head should be rested on a pillow. Only after abdomen is in relaxed position palpation should be proceeded.

4. Missing points on palpation:
a. Remember to ask for pain in any site before palpating. The part with pain should be skipped and palpated at the end.
b. Look for rigidity and guarding besides tenderness.
c. Tenderness should be assessed by looking at facial expression +/- guarding
d. Remember to palpate urinary bladder
e. Hernial orifices should be palpated and is commonly missed point.
f. Make the patient sit and check for renal angle fullness and tenderness.


Rarely grading can be asked.


5. Remember- Shifting dullness is done in percussion and fluid thrill is done in palpation, in a patient with abdominal distension.

6. Auscultation- Look for Renal bruit, Hepatic bruit etc in indicated cases. Bowel sound  should be listened to. When bowel sounds are not present, one should listen for a full 3 minutes before determining that bowel sounds are, in fact, absent.



Recommended reading
https://meded.ucsd.edu/clinicalmed/abdomen.htm
http://www.ncbi.nlm.nih.gov/books/NBK420/

Friday, July 15, 2016

Birth Asphyxia and its manifestations

Definition: Birth asphyxia Birth asphyxia is defined as a reduction of oxygen delivery and an accumulation of carbon dioxide owing to cessation of blood supply to the fetus around the time of birth.

Although , APGAR score is retrospective scoring , it has been used to assess the severity of Asphyxia.
Apgar score 8~10: no asphyxia
Apgar score 4~8: mild
Apgar score 0~3: severe



Clinic manifestations
Complications:
CNS: HIE, ICH
Respiratory system: MAS, RDS, pulmonary hemorrhage
CVS: heart failure, cardiogenic shock
Gastrointestinal system: NEC, stress gastric ulcer
Others: hypoglycemia, hypocalcemia, hyponatremia

Diagnosis
American Academy of Pediatrics (AAP) and the American College of Obstetrics and Gynecology (ACOG) suggest that all of the following must be present for the designation of perinatal asphyxia severe enough to result in HIE:
  1. Profound metabolic or mixed acidemia (pH < 7) in an umbilical artery blood sample, if obtained
  2. Persistence of an Apgar score of 0-3 for longer than 5 minutes
  3. Neonatal neurologic sequelae (eg, seizures, coma, hypotonia)
  4. Multiple organ involvement (eg, kidney, lungs, liver, heart, intestines)
Suggested reading: Thompson Scoring for HIE

Here is the details for MBBS students on HIE- A CNS manifestation of Asphyxia




Any confusions can be cleared from author through comments. Feedback are welcomed.

Sunday, May 29, 2016

BIND Score in severe hyperbilirubinemia


Bilirubin-induced neurologic dysfunction (BIND) Score is used to assess bilirubin induced encephalopathy in neonates with severe hyperbilirubinemia. Johnson et al developed the BIND score to help identify an infant who requires more aggressive monitoring and management.
Parameters:  3 Parameters are assessed and scoring is done based on the parameters.
(1) cry pattern
(2) behavior and mental status
(3) muscle tone

Click to enlarge

BIND score = total score (points for all 3 parameters scored separately and added)
Tick all that apply, but total score is based on the highest in each category or 9.
Interpretation:  minimum score: 0  , maximum score: 9
BIND Score
Stage
1 to 3
Stage 1A
4 to 6
Stage 1B
7 to 9
Stage II

Stage of BIND
Features
IA
minimal signs; totally reversible with therapy
IB
progressive signs but reversible with therapy
II
irreversible signs but severity decreased with prompt and aggressive therapy

References: 
Johnson L, Brown AK, Bhutani VK. BIND - A clinical score for bilirubin induced neurologic dysfunction in newborns. Pediatrics. 1999; 104 (Supplement): 746-747.
http://www.meducator3.net/algorithms/content/clinical-severity-acute-bilirubin-induced-neurologic-dysfunction-bind-score
Resource for reading
http://pediatrics.aappublications.org/content/134/5/e1330 

Tuesday, April 12, 2016

Age Terminologies during perinatal Period


A. “Gestational age” (or “menstrual age”) is the time elapsed between the first day of the last normal menstrual period and the day of delivery. The first day of the last menstrual period occurs approximately 2 weeks before ovulation and approximately 3 weeks before implantation of the blastocyst. Minor inaccuracy 4–6 days if cycle is regular and recall is accurate. Gestational age is conventionally expressed as completed weeks.



B. “Chronological age” (or “postnatal” age) is the time elapsed after birth. It is usually described in days, weeks, months, and/or years.

C. Postmenstrual age is the time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (chronological age). Usually described in number of weeks and is most frequently applied during the perinatal period beginning after the day of birth. For postnatal management reason, a week + days can be used.

D. “Corrected age” (or “adjusted age”) is a term most appropriately used to describe children up to 3 years of age who were born preterm. Represents the age of the child from the expected date of delivery.

Corrected age = chronological age- [ ( 40wks - Gestational Age)X mth/4 weeks]

E. “Conceptional age” is the time elapsed between the day of conception and the day of delivery. Because assisted reproductive technologies accurately define the date of fertilization or implantation, a precise conceptional age can be determined in pregnancies resulting from such technologies.


To avoid confusion, the term “gestational age” should be used. The terms “conceptional age” and “postconceptional age,” reflecting the time elapsed after conception, should not be used.

Gestational age is often determined by the “best obstetric estimate,” which is based on a combination of the first day of last menstrual period, physical examination of the mother, prenatal ultrasonography, and history of assisted reproduction.


The best obstetric estimate is necessary because of gaps in obstetric information and the inherent variability (as great as 2 weeks) in methods of gestational age estimation.

Postnatal physical examination of the infant is sometimes used as a method to determine gestational age if the best obstetric estimate seems inaccurate.

Therefore, methods of determining gestational age should be clearly stated so that the variability inherent in these estimations can be considered when outcomes are interpreted

SOURCE: Pediatrics November 2004, VOLUME 114 / ISSUE 5 Age Terminology during the Perinatal Period


Terminologies related to weeks of Gestation

In a joint Committee Opinion, The American College of Obstetricians and Gynecologists (The College) and the Society for Maternal-Fetal Medicine (SMFM) are discouraging use of the general label ‘term pregnancy’ and replacing it with a series of more specific labels: ‘early term,’ ‘full term,’ ‘late term,’ and ‘post term.’ The following represent the four new definitions of ‘term’ deliveries:
  • Early Term: Between 37 weeks 0 days and 38 weeks 6 days
  • Full Term: Between 39 weeks 0 days and 40 weeks 6 days
  • Late Term: Between 41 weeks 0 days and 41 weeks 6 days
  • Post term: Between 42 weeks 0 days and beyond


Preterm: All babies born at less than 37 weeks gestation
  1. Late Preterm: 34 weeks to 36 weeks +6 days
  2. Preterm: 23 weeks to 33weeks + 6 days

Monday, March 28, 2016

Top Protein rich foods for your diet


The daily nutrients requirement of body includes vitamins and minerals, carbs, protein, calcium, and others. Amongst them all, protein is one vital nutrient you should add to your diet because protein is the bunkers of amino acids. It keeps you active and fit throughout the day and keeps you regain the lost muscle power. Here is the list of top protein rich food you should add in your diet.


[ Note: This magazine article is for general readers- parents and not intended for infant and small children]



Fish
Fish has the highest amount of protein content in it. It has 26g of protein in every 100g. It also contains less amount of saturated fat. The nutrients present in fish are very good for health. Add fish in your diet and see the magic happen inside out.




Eggs
Eggs are a good source of protein. Be it boiled, scrambled or half fry, eggs are pretty much effective in providing necessary nutrients. Every 100g has 13g of protein packed in it. Pack some eggs in your tiffin box and eat it in breakfast or lunch or brunch, it is good any day.



Nuts
Are you nuts about nuts? Nuts are a very rich source of protein. It is rightly said, wonders packed in a small packet. Every 100g has 13g of protein in it. You can also check out the organic protein supplements on Netmeds. Use the netmeds coupons to avail the offers. Almonds, cashew, and peanuts are very rich in protein. Brazil nuts have the highest amount of protein invoked into it. So, fill your pocket with some nuts.



Dairy Products
Dairy products are some natural source of protein. There are numerous dairy products and some of them are milk, curd, cheese, and butter. Add any of these in your daily diet and witness the difference. A glass of milk in the morning, a toast with butter, a cheese sandwich, or a bowl of curd, fancy anything you like in any manner. Protein is all yours.



Chicken
Chicken is also a very good source of protein and admit it, everyone loves chicken no matter what form it has been cooked to. Boiled, fried, or baked, chicken is going to provide you some protein. There is 26g of protein in every 100g.






Beans
Vegetarians rejoice! There is something for you in Santa’s sack too. Beans are a great option when it comes to protein. Every 100g contains 17g of protein filled in it. Beans comes in variety of forms like black beans, white beans, mung beans, lima beans, and more. Also, they are very low in fat. For more, try surfing through  1mg for nutrition products. Don’t forget to use 1mg coupons to get the best offers.


Dates

Small in size but high on nutrition, Dates are among the natural source of protein. They also contain vitamin A, B, and C, fibre and iron too. Every single date has 0.22g of protein and 100g contains 2.50g of protein. Fill your bottom pockets with some dates to remain charged on the go.



Bananas

Bananas are the easiest type of fruit to grab a bite off. Just peel the skin and result is the healthy yet yummy fruit for you. Also, bananas are among the healthiest fruits, which contain 4g of protein in every 100g. You can mix bananas with almost anything be it milk, oats, cereals, salad, sandwich and more. People who have constipation problems, bananas are for you as well. Its skin is good for skin too. So, the next time you throw the skin of a banana think again.

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Author Profile:

Neha Choudhary is a content writer and content marketing specialist at Cashkaro. She is a writing fanatic and when she’s not writing, she is travelling and cooking. 
Being a book lover and a movie enthusiast, her mind is constantly revolving around new ideas. As a person, it’s a treat being around her owing to her jolly nature.



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