139

Monthly Clinical Meeting

At Department of Pediatrics, SSG Hospital, Vadodara.

1. 8.00 am to 8.20 am Unusual case .. Short Presentation

- Dr. Anand Naragal

2. 8.20 am to 8.40 am Case report of calverian tuberculosis

- Dr. Varsha Shah

3. 8.40 am to 9.00 am Journal Scan

- Dr. Snhel Shirolawala

Clinic Meeting Sponsored by:

Samarth Life Sciences Pvt. Ltd. INSED ATOMISER

(Midazolam nasad spray (5 mg/ml))

20-08-2009

Thursday

140

Quiz - 5

Regarding the cumulative scores, Dr Sanjeev Goel is leading with the score of 44, Dr Bhavesh Shah and Dr Nisarg are having second position at 42 & Dr Parul Valia having nearly the same score of 41. Dr Hitesh Desai is at 39 and Dr Samir Shah having score of 38. I think it will be interesting to witness the dynamics of the scores.

Q. 51 A 10 year old boy with insulin dependent diabetes, on a twice daily routine of long and short acting insulin, reports regular hypoglycemia while playing football in the afternoon. To prevent this problem, you should advise him to

a. give less short acting insulin before breakfast

b. test his urine for sugar before playing football

c. give up playing football

d. eat extra carbohydrate such as a small chocolate bar before football and to take glucose tablets when he begins to feel lightheaded.

Q.52 A 3 years old boy is brought to hospital after choking while eating peanuts. He was wheezy for a few minutes but is now asymptomatic. Regarding this which of following is a correct statement?

a. a chest X-ray is not indicated because a peanut is not radio-opaque.

b. the risk of lung damage is less because the inhaled material is organic.

c. if he remains asymptomatic for 24 hours and physical examination is normal, he may be safely discharged home without further investigation.

d. bronchoscopy should be performed as soon as possible.

Q.53. All of the following conditions can be reliably diagnosed by mucosal biopsy except

a. Sucrase deficiency

b. Cystic fibrosis

c. Helicobacter Pylori infection

d. Hirschprung’s disease.

Answers to Quiz No. 5 are

41. A

42. B

43. A

44. D

45. B

46. B

47. D

48. D

49. B

50. D

Congratulations to the top scorers. The names of the top scorers are as follows :

Score 09 :

- Dr Sanjeev Goel,

- Dr Nisarg Shah

- Dr Samir Shah,

Score 08 :

- Dr Parul Valia, - Dr Bhavesh Shah,

- Dr Ashutosh Patel - Dr Hitesh Desai

Score 07 :

- Dr Sanjay Majmudar,

With kind permission from AOP Vadodara, Post Graduate Students of the Pediatric Department Medical College Baroda were happy to participate this time for the quiz. Practicing pediatricians with busy practice have scored much better. I think students should work hard to improve their performance.

Score 07 :

- Dr Amit Jetani - Dr Neha Jain

- Dr Saurabh Modasiya - Dr Manan Parikh

Score 06 :

- Dr Mandar Kale - Dr Sushma T. S.

- Dr Komal Parekh, - Dr Tarun Parmar

Dr. Paresh Thakkar

pareshthakkar@yahoo.com

141

Q.54 All of the following may be the presenting feature in case of Coaractation of the aorta except

a. clinical features suggestive of septic shock in an infant

b. pain in the legs on exercise in a school age child

c. rib notching on a chest X-ray.

d. postural hypotension in an adolescent.

Q.55 A 13 year old child is having low grade fever and arthralgia. There is past history of hepatitis A infection 1 year before. 10 days before he had pharyngitis which was treated with penicillins. On examination he is having BP of 154 / 92 and mild pitting pedal edema. Rest systemic examination is normal. Regarding laboratory investigations, Hemogram is normal, urine showing large amount of protein and presence of plenty of RBCs and RBC cast in urine microscopy. S Creatinine is 1.7, serum electrolytes and blood urea is normal.

Which of the following is likely cause of his renal dysfunction?

a. Allergic reaction to Penicillins

b. High levels of compliment

c. Immune complex mediated damage

d. Previous infection with Hepatitis A.

Q.56 A 4 year old child is brought to the emergency room by the parents. Parents found him in the floor of bathroom barely breathing. The contents of the medicine cabinet as well as the cleaning products kept under the sink appear to have been disturbed. His heart rate is 150/min, Respiratory rate is 8/min, BP is 60/35. The child is intubated. Multiple attempts to establish venous access have failed. Regarding fluid management which of the following would be the most appropriate next step

a. Administration of fluid via Naso-gastric tube.

b. obtaining Central venous access

c. taking intra-osseous line

d. performing saphenous cut down

Q.57. A 12 year old child with Chronic Persistent Asthma presents with cough and breathlessness. He is on inhaler therapy and some other oral drugs for the treatment of asthma. He has suffered 4 episodes of respiratory tract infection out of

which he was required to be admitted twice. Presently on examination he is having tachypnea with significant respiratory distress and cyanosis. Respiratory system examination is showing bilateral extensive rhonchi. Which of the following blood gas analysis and electrolyte values are most closely matching with the given clinical situation?

pH pCO2 pO2 Na K Cl HCO3

a 7.3 22 98 140 4.0 105 16

b 7.55 25 99 140 4.0 108 25

c 7.34 54 52 137 4.0 96 35

d 7.24 24 99 136 4.0 96 12

Q.58 A 16 year old boy has been reported to emergency room after suicidal ingestion of Aspirin tablets. On examination the child is drowsy and tachypnic. Which of the following blood gas analysis and electrolyte values are most closely matching with the given clinical situation?

pH pCO2 pO2 Na K Cl HCO3

a 7.3 22 98 140 4.0 105 16

b 7.55 25 99 140 4.0 108 25

c 7.34 54 52 137 4.0 96 35

d 7.24 24 99 136 4.0 96 12

Q.59 A six month old boy has been brought to emergency room by mother. He has developed intense burning, itching and redness of the skin after sun exposure for five minutes. Urinary porphyrins are of normal levels. Which of the following is most likely diagnosis for this child?

a. Congenital Erythropoietic Porphyria

b. Erythropoietic Protoporphyria

c. Heriditory Coproporphyria

d. Porphyria Cutanea Tarda

Q.60 Colitis is associated with all of the following except

a. Cow milk protein allergy

b. Coeliac disease

c. Campylobacter infection

d. Hirschsprung’s disease.

Please email your answers

toiapbarodaquiz@gmail.com or send sms to

Dr. Paresh Thakkar on 9426032150

Last Date : 31st August 2009

142

The Matters of MoneyDr. Niranjan Shendurnikar

It’s a wise idea to treat money with respect. Money

plays an important role in our lives and it is a

common tendency that as we earn more, we also

want more of it. The way that you are going to

utilize your money and set your financial priorities

would to a large extent determine the way you are

going to live your life. Whether one is a salaried

person or a businessman, each one wants to keep

his/her money intact, acquire assets and let the

money beget more money.

Financial education or financial literacy is

basically learning how to spend money wisely and

what to do rightly after you make it. The good idea

about money should be to keep it longer, invest it

wisely and make it work for you. The financial

success stories of McDonald’s, Henry Ford,

Naresh Goyal, Azim Premji, Sunil Mittal and many

others are a result of their brilliant minds,

entrepreneurship, technical brilliance and

managerial skills. Sylvia Porter, a renowned

financial expert says that the money can be

translated into a beauty of living, or a support in

misfortune, on education or future security. Many

people often go overboard buying different stuff

and things. While there may be nothing wrong in

having things but if becomes your only pursuit, it

would never make you totally satisfied. Do not let

the stuff and things dominate you.

We are living in exciting and prosperous times

where we have potential growth opportunities and

expanding new directions for economy. If we have

timely information and are willing to be bold and

take some risks we can convert our money into

real power, energy and happiness. Interest rates

go up and on, gold values fluctuate, real estate is

finally coming out of dumps and the stock market

is doing a war dance. How do you decide where

to invest your money? No doubt your needs may

be less but we need to save now when we can.

The first step towards wealth creation is saving.

You must spend less than you earn, then save and

invest the difference wisely. Let your savings

become the seeds of your wealth. Strategies such

as setting financial goals, and assessing the

involved risks should be able to guide you through

your financial planning and responsibilities ahead.

Apply your financial knowledge consistently in

your personal and professional finances to let you

become a financial success in your life. Plan your

investments before hand to reap optimum profits

and minimize the risks. Think about your goals,

children’s education, marriage, medical expenses

and retirement and plan step by step. Diversifying

the investments, not putting all the eggs in one

basket, considering market fluctuations and

optimizing short term and long term investments

have become increasingly essential to ensure

good value for your money.

Never, never lose control of your assets. It was

not a long ago ‘Baghbaan’ and quite a few other

movies showed us what a great folly it would be to

mix together a filial love and assets. People have

entrusted their hard earned money to others only

to have their trust betrayed later. Be financially

independent, secure and powerful. If money is

what you want to make and grow, make financial

literacy a continuous process. Don’t earn to spend

only. Learn to earn to make your money earn for

itself. Let your own financial intelligence make the

money work for you rather than you working for

money. Let your meticulous planning become the

harvest for tomorrow’s returns. Examine, analyze,

reassess your financial needs, develop a strategy

and get rewarded happily and financially!

drniranjan@rediffmail.com

drniranjan@rediffmail.com

and the father(Thomas Button) takes the baby and

abandons him on the porch of a nursing home.

Given a little chance of survival, but who does

survive and over the course of the story Benjamin

becomes to grow younger biologically. Benjamin

is raised by a black woman who’s a caregiver at a

seniors’ home. Daisy's grandmother was a

resident at that home, which is where she first met

Benjamin. Although separated through the years,

Daisy and Benjamin remain in contact throughout

their lives, reconnecting in their forties when in age

they finally match up. Subsequently after many

years, they both fall in love each other at about

same biological age. They experience the 1960s

together, in large part blissfully but increasingly

aware of Benjamin growing younger while Daisy

grows older. Interspersed in between are the

beautiful relationship shown between Benjamin

and his caretaker/mother, his affair with a married

older woman, explorations over the seas and

Russia and his relationship with his dying father.

Towards the end, 84-year-old Benjamin, who is

now physically an infant, closes his eyes as to

sleep and dies in Daisy's arms.

There are several poignant moments through out

the movie.There is an abundance of rich story

telling backed by fantastic performances. This is a

kindly sweet hearted movie filled with lots of truly

touching stuff about impermanence, love and loss.

The movie is a masterful piece of art replete with

outstanding cinematography, special effects,

make up work and the set design, for which it has

deservedly won three Oscar awards. David

Fincher, the director has treated the script with a

visual bravura and narrative gusto usually beyond

the routine Hollywood mainstream. The story is

indeed curious and a long one indeed (nearly

three hours) with a rambling exploration of time

and what one makes of it during his/her life.

143

The Curious Case of Benjamin Button Dr. Niranjan Shendurnikar

The Hollywood movie , The Curious case of

Benjamin Button (2008) is an epic fantasy tale set

up in the historical period after World War 1 and

thereafter. The movie rolls backwards from the

year 2005 on the day when Hurricane Katrina hits

New Orleans in USA and elderly Daisy Williams

who is on her death bed asks her daughter

Carolene Williams to read to her the diary which

recounts the entire extra ordinary life of her long

term friend Benjamin Button As the narration

begins the viewers are taken back to the era at

the end of World war 1(1918) when a baby

boy(Benjamin Button), played superbly by Brad

Pitt, is born with the unusual appearance and

physical maladies of an 85-year-old man. The

mother of the baby dies shortly after giving birth,

144

Movie Review

Jay(Saif Ali Khan) enters into a relationship with

Meera Pandit (Deepika Padukone). They are

practical, material people who do not allow their

hearts to rule over their head. Especially, Jay does

not believe in ‘love’, ‘marriage’ and being committed

to one soul mate all through one’s life. Jay has been

aspiring to migrate to the US for some time and been

working at it. Meera works into fresco paintings. She

gets a job assignment in India. When she decides to

move to India, they mutually decide to end their

commitment to each other and move on in life on a

happy note. They even throw a ‘breakup party’ for

their friends, and make it known to all that they are

Dr Bankim Parikh

separating out and hence once again ‘available’.

Soon they start missing each other. Their friendship

blossomed further. They became more casual, more

frank and outspoken, and began enjoying their

friendship more than ever before. It was somewhere

here that Meera realizes that this relation is much

more than friendship. Jay, though he feels and goes

through the emotional trauma of missing Meera,

refuses to admit that he can ever fall in ‘love’ or have

permanent relationship. Both try to have new

partners in their respective lives, but cannot forget

each other. It takes a long time for Jay to finally

realize, accept, and admit that he was in love with

Meera.

Interspersed in this story is another story in

flashback- that of Sardar Veer Singh ( Rishi Kapoor)

and Harleen (Gisssele). Veer’s younger days are

played again by a turbanated Saif ali Khan in double

role. This story is that of ‘love at first sight’; fully

committed to each other, of sacrifice, decision to be

together for eternity – a complete contrast to the

main story.

The common factor between the two stories is that

despite the changes in the way one thinks and

behaves in these ‘progressive’, practical times, the

‘feelings’ remain the same over the ages. ‘Love’ has

remained the same over times immemorial.

bankimparikh@hotmail.com- Love aajkal

My rating ***

Bankim Parikh

Indiatimes rating ***

Release Date : July 31, 2009

Director : Imtiaz Ali

Star Cast

Saif Ali Khan...... Jai Vardhan Singh

Deepika Padukone...... Meera

Giselle Monteiro...... Harleen Kaur (introducing)

Rishi Kapoor...... Veer

Rahul Khanna...... Meera's boss

Neetu Singh...... Veer's wife

Vir Das...... Shonty

Raj Zutshi...... Harleen's father

Singers :

Neeraj Shridhar,

Master Saleem,

Suzi Q,

Sunidhi Chauhan,

Mohit Chauhan,

Rahat Fateh Ali Khan

K K

Lyricist : Irshad Kamil

Music Director : Pritam Chakraborty

145

02 Sept. Kairavi Pancholi

02 Sept. Jahnavi Sanjay Shah

03 Sept. Satish Daksha Shah

04 Sept. Himanshu Parul Chauhan

04 Sept. Rupal Bhavesh Shah

06 Sept. Nita Mehul Shah

07 Sept. Kamla T.B Patel

07 Sept. Rajesh Urmi Parikh

08 Sept. Ramila Dhanteja

09 Sept. Atharva Ravindra Pradhan

10 Sept. Sahil Sanjay Majmudar

12 Sept. Disha Ashvin Shah

13 Sept. Harshil Haresh Patel

13 Sept. Neha Mukesh Chandiramani

Birthdays and Anniversaries

Birthdays

15 Sept. Beena Divyakant Patel

16 Sept. Ashutosh Patel

16 Sept. Parita Satish Pandya

17 Sept. Arun Phatak

18 Sept. Nitin Agarwal

20 Sept. Sanjay Shah

22 Sept. Nirupa Munshi

22 Sept. Heena Ritesh Shah

22 Sept. Swetal Sunil Fajalia

23 Sept. Shalin Bankim Parikh

25 Sept. Dhairya Shreyas Shah (Jr.)

26 Sept. Arpit Nina Joshi

27 Sept. Saakshi Sanjeev Goel

With Best Complements from :

Vrundavan PharmaDeepak Sheth (Kaka) Mobile : 98254 59318

94265 62272Available :

All Pediatric range, Syrup, Susp. Medicine, Antibiotics,

Injections Tablets of ethical generic company

Surgicals Goods :

Mediflon, Neocan, Vainflow, Neoflon,

I/V Set, S/V Set, P/D Set, Dis. Sy.- BD

11, Shivang Flats, B/h. Suryanagar Bus Stop, Waghodia Road, Vadodara - 390 019.

146

AMRIT KRISHNAHEART CARE CLINIC

102, A-1, Sheetal Apartment, Opp. Panchratna,Subhanpura Road, Ellorapark, VADODARA-23

Dedicated Pediatric Cardiologist

M.D. (Ped.), Fellowship in Pediatric Cardiology

Dr. Mahesh Bhatt

Visit By Appointment Only

Contact No. 09825029744

147

HAEMOCARECENTRECentre for Diagnosis & Treatment Counseling

Blood Cancer

Leukemia

Lymphoma

Myeloma

v

v

v

Anemia

Congenital

Acquired

v

v

ITP (Immune Thrombocytopenic Purpura)

Hemophilia A & B

Von Willebrand Disease

DIC

TTP

Other Congenital & Acquired Bleeding Disorder

v

v

v

v

v

v

Bleeding Disorders

Thrombotic Disorders

DVT (Deep Vein Thrombosis)

Pulmonary Embolism

Cerebral Vein Thrombosis

Congenital & Acquired Thrombophilia

v

v

v

v

Dr. Seema Bhatwadekar M.D.Consultant Haematologist & Oncohaematologist

101, Berry's Plaza, 11-A, Shrinagar Soc., Above samsung Shoroom,

Akota Road, Vadodara - 390 020. Ph. (C) 0265-2321776 (M) : 93745 11709

E-mail : ssbkar16@gmail.com

Please visit our Website – topranilabs.com for details

E mail - topranilabs@hotmail.com

Toprani Advanced Lab Systems

Stem Cell Estimation (CD34 Positive) by Flow Cytometry

According to ISHAGE guidelines

(Please contact lab for details)

Also available CD4/8/3 and HLA B27 by Flow Cytometry

New Introduction

Pediatric Surgeon

Dr. Siddhartha NayakM.S.(Gen. Surgery)

M.Ch. (Pediatric Surgery: P.G.I.; Chandigarh)

On Panel:

[1] S.S.G.H. and

Govt. Medical College

[2] K. G. P. Children Hospital

[3] O.N.G.C.

Hospital :

Sanstha Vasahat, Pratap Road,

Raopura,Vadodara -390 001

Mobile: 98250 62271

Tele No: 0265-245 99 77

148

Did you know?

• It is one of the commonest congenital anomalies only second to spina bifida and cleft lip and palate.

• It is also the commonest anomaly which is missed by clinicians during routine check ups.

• Not correcting it in time (before school going age which is now 2 years) can lead to severe psychological effects on child’s mind.

• Most hypospadias can now be corrected as single stage repair with fistula rate of as low as 5 -10 %.- starting at 1 year of age.

• As high as 20 % of proximal

At Neel Surgical Hospital for children…………

• More than 200 cases of hypospadias operated in last 7 years

• Modern techniques for surgery and treatment like

- Caudal anesthesia – more safe, excellent post op pain relief.

- Usage of loops for proper placements of microstitches.

- Silastic catheters for urethra to minimize irritation.

- Drugs to decrease postoperative bladder spasms.

are employed.

• All thru out the stay child is kept busy with children friendly staff, cartoon shows, Children’s Books from ‘My library’ and

Neel Surgical Hospital for childrenKaram Dham Complex, Near Atithigruh , Akota, Baroda.

For appointments : please call 0265-2312680

Hypospadias

Dr. Darshana Naik MD

Consultant Pediatric Neurologist

Fellow Pediatric Neurology, Hinduja Hospital, Mumbai.Fellow Pediatric Neurophysiology, London,UK

Asian Child Neuro Clinics and Cerebral Palsy Centre2nd Floor, Park Avenue Building, Opp. Parimal Garden, Besides Piramyd Mall,

Ellisbridge, Ahmedabad. Phone : 079 - 26400640 • 9924181291

Facilities Available :

EEG, VideoEEG, EMG, NCV, BERA, VEP, SSEP, ERG

IQ test, Aptitude test, ADHD, Autism management

VISITING PEDIATRIC NEUROLOGIST : (BARODA)

1) Kashiba Children Hospital : First SATURDAY OF MONTH 9-11 AM

2) Unity-Sterling Hospital : First SATURDAY OF MONTH 11-1 PM

DEVELOPMENTAL CENTRE

KRISHNA

149

Services offered :

• Early intervention program for the NICU graduates

• Hearing screening by OAE

• Diagnostic BERA

• PT, OT, Neurodevelopment techniques

• Speech therapy

• Dasii & IQ testing

• Cognitive stimulation, Play therapy

• Counseling for behavioral problems

• Special education for LD & MR children

• Sensory integration for autistic children

Olive 2, Bhavanipura Society, Next to Haveli, Nizampura, Vadodara - 2. Ph. : 0265-6581121Time – 9: 00 A.M. – 7: 00 P.M – Prior appt. necessary

'TOWARDS A BETTER FUTURE'

202, Nimbalkar Chambers,

Kharivav Road,

Dandia Bazaar,

Vadodara.

Ph. – 2410390

S-9, National Plaza,

R.C. Dutt Road,

Alkapuri,

Vadodara.

Ph. - 2359792

150

OM ORTHODONTIC CLINIC

email : anju_gohil@rediffmail.com • www.dranjugohilparikh.webraj.com

101, Profit Centre, Kalaghoda, Sayajigunj, Vadodara - 390 005.

Tel : (C) 6544699, 2225999 (M) 98250 40106 (R) 2433888

Dr. Anju Ajit Gohil / Parikh (M.D.S.) Orthodontist

Specialist in :

Correcting Protruded & Irregular Teeth &

Abnormally Growing Jaws.

Consulting & Visiting Orthodontist

Visiting Hours : 10 am to 1 pm

5 pm to 8 pm

Exclusive

Orthodontics

Best compliments from

Padmasana Dental ClinicDr. Bhavna Haresh Dave

M.D.S. (Pedodontia)

Specialist in: Children Dentistry

151

With Best Compliments

Dr. Bhavesh M. ThakkarPediatric Interventional Cardiologist

Mobile : 9898022444

Add. : 1. U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad

2. Krishna Heart Institute, Ahmedabad

Distributors/Stokists : (Surgicals)

• B-d India Ltd.

• Medicare Hygiene Pvt.ltd.(medica Brand Dressing Material)

• Sangam Healthcare Products Ltd. (safti Brand Of Products)

• Kohinoor Products( Gauze/bandages)

• Deepak Surgical (gallant Razor/skin Mate Skin Stappler/parakin

Latex Gloves/cardio Tec Ecg Electrodes/daxi Flo I.v.regulator.

• Kam Som Industries (abs.cotton)

• Melody Plastic Products Pvt.ltd. (pov.iodine Etc.)

• Safeflo Urin Bag.

• Jms ( I.v/tape/scalp Vein Etc)

• Primwear(india)

DOSHI SURGICALS

“Dealers In Surgical Disposable Items, Rehabilitation Aids, Consumer Goods, Wide Range Of Innovative Medical Items. “

Established: 1995 Mobile No: 9825043592

Other Dealings :

* Ethicon (j&j) Sutures / * Nulife Gloves / * Kaltex Gloves / *alpha / I.v.fluids / leucoplast / b.brown / romsons/etc

Orthopedic/rehabilitation Aids

• Lp Supports,usa( Exclusive Range Of Neoprene &

Elastic Supports)

• Ortho-royal Inc.,bombay (wide Range Of Rehab/

splints/footcare)

• Foot & Ankle Co.,bombay( Foot Care Products/footwear)

• Samson Scientific & Surgicals.indore

• Falcon Heating Pads

Proprietor: Bhadresh Doshi

Useful Products:

Quality Walking Aids/ Toilet Chairs/ Commodes / Wheel Chair/ Urin Pots/ Bed Pan/ Water Bed/ Air Bed/steam Inhalers/

weighing Scale/ Etc.

152

Head by

Dr. Jitendra Jethani

Consultant Pediatric Ophthalmologist

MS, DO, DNB, FNB

For Appointment Call

0265 - 2410932, 2426311

Services Available :

Age appropriate vision testing

Orthoptic workup

Amblyopia management

Pediatric Neuroophthalmology set up

Orthoptic exercises

Surgical services available :

Pediatric Cataract : with posterior capsulorrhexis

Sutureless squint surgeries

oblique muscle surgeries

Transpositions/Jensen's/Knapp's/Harada Ito surgeries

Management of double vision/diplopia.

Dr. Thakorbhai V. Patel Eye Institute

Sheth M.L. vadiwala Eye HospitalHaribhakti Complex, Vinobha Bhave Marg, Salatwada, Vadodara - 01.

tvpeyeinstitute@yahoo.com, www.tvpei.org 0265 - 2410932

Pediatric Eye careOne of its kind in the city

Fully functional

Offers

122