ACHARS TEXTBOOK OF PEDIATRICS PDF
Since the publication of the first edition in , Achar s Textbook of Pediatrics has quickly established its reputation as one of the classic textbooks on the. Since the publication of the first edition in , Achars Textbook of Pediatrics has quickly established its reputation as one of the classic textbooks on the. Find Achar's Textbook Of Pediatrics by Bhat, Swarna Rekha at Biblio. Uncommonly good collectible and rare books from uncommonly good booksellers.
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Seller Inventory Fourth Edition. Printed Pages: In this, the fourth edition of the book, the content has been updated and revised to reflect current approaches and knowledge. New images, colour photographs, a CD with additional content and up-to-date tables and graphs have also been added. Seller Inventory OBS Book Description Condition: This is Brand New.
Seller Inventory Orient Achar's Textbook of Pediatrics. Swarna Rekha Bhat. Orient Black Swan , Relatively new problems to pediatrics, such as acquired immune deficiency disease and Kawasaki disease, are effectively reviewed by recognized authorities. Hypertension, an uncommon problem in pediatric patients, is adequately addressed, and the criteria for its diagnosis are emphasized. The libraries of medical schools, pediatric departments, and hospitals and the pediatric practitioner's office itself will not be complete without the "bible" of the specialty.
Edmund C. Burke, M. Gussenhoven and Anton E. The two authors work at different institutions in the Netherlands and are trained in different specialties, cardiology and pathology.
In addition, one is just beginning her academic career, whereas the other has been an established authority in his field for some time. This heterogeneity seems to have been an asset rather than a handicap, however, as the product of their efforts is a book that will be of value to anyone who is interested in the application of echocardiography to patients with congenital heart disease.
This text is primarily an atlas in which photographs of anatomic specimens are compared with two-dimensional echocardiograms of similar anatomic sites and pathologic conditions. The anatomic specimens are beautifully sectioned and prepared, and the photographs produced from them are of excellent quality. The echocardiograms are also well done and certainly convey the intended message, although direct comparisons of echocardiograms and high-quality photographs of cardiac anatomy reemphasize the fact that even though rapid progress has been made in the quality of echocardiographic images during the past 5 years, there is still room for substantial improvement with this modality.
In addition, two-dimensional echocardiography is a dynamic imaging tool that puts its best foot forward only when the images obtained are displayed in real time on a television monitor or videotape; selected still-frame reproductions inevitably lose something in clarity and in the amount of information conveyed. The authors have deliberately and wisely limited their book to a demonstration and discussion of normal cardiac anatomy and the common congenital cardiovascular malformations, not attempting to cover the entire spectrum of complex and rare congenital lesions.
In addition to the anatomic and echocardiographic photographs, the nicely integrated text discusses possible pitfalls in echocardiographic technique which can lead to mistaken interpretations, and it also carefully discusses anatomic features that are especially important in the diagnosis of the various malformations. The text is particularly valuable in that both the echocardiographic and the anatomic observations are based on the principle of sequential chamber analysis, a concept that has greatly simplified and clarified the description of the pathologic changes associated with congenital cardiovascular lesions in recent years.
This book is very well done and will be useful to anyone who is interested in the field of congenital heart disease. I suspect that it will be of particular value to the student or resident who is relatively early in his training, as the format in which the material is presented and the approach that is used simplify what can be a complex and confusing field.
Douglas D. Mair, M. Beneken and S. Most of the practicing physicians will require consulting an academic colleague to choose the appropriate study design.
C S Next step in the process is to locate the best evidence that attempts to answer the research question identified. There are a number of online information and electronic data bases that the clinician may tap to find the evidence.
Every hypothesis has also four components: Study design and how the potential biases have been handled are critical factors determining the validity of the findings of an article. How is malnutrition associated with increased risk of infections? The best ideas for research come from everyday clinical problems. Collaboration with universities or medical schools is other option to generate resources. In a network.
Simple trials can be done in office practice. Keeping in mind the methodological limitations and potential biases. Natural history of common childhood diseases can also be easily researched. Loneliness of solo practitioners and emotional involvement with patients are additional barriers. PBRN were initially set-up as a surveillance network to report on common diseases and clinical problems or diseases of public health importance. C N R B The practice based research network can be considered the research laboratory of the primary care setting.
Professional associations such as Indian Academy of Pediatrics may be able to facilitate and mobilize funds from donors. Office based practitioners can answer many important clinical questions that are not necessarily important for those attending big hospitals. The key elements in a PBRN are: Obtaining grants by individuals is more difficult compared to when PBRN approach for funding.
During last two decades. Electronic data collection at the point of care is a feasible solution. PBRN must receive approval from many ethics committees to conduct research in several locations and practice settings. Some examples may include: The support from the industry is justified provided issues related to conflict of interest are taken care of and independence along with scientific rigor of the work are consistently maintained.
Managing network brings with it some unique challenges as well. Subsequently these networks have been involved to answer and shed new light on the complex. Research networks have been set-up.
Data collection must not put too much burden on the busy practitioner. This has restricted the opportunity for pediatricians and family physicians to improve the quality of care in office practices. Funding for practice based research is definitely a major barrier but not that is insurmountable. Studies such as these most often result from joint contributions of office based physicians and hospital based consultants.
The design of such network studies have to be kept simple and easy. Clinical trials are examples of analytic studies. The research coordinator is of critical significance. Practice Based Research Network PBRN is a number of primary care clinics grouped together in a structure of a network for the purpose of performing research in the community.
Sentinel surveillance. It is important that data collection methods match the study design for accuracy and comfort. Slora E. J Am Board Fam Med. David WR. Hickner JM. Wasserman RC. Practice based research network—the laboratories of primary care research. Ipp M. Pace WD. Pediatric Child Health. Delivering on an opportunity. Medical Care. Pediatric Clinical Research Networks: Current Status. Pediatric research in office settings PROS: Bocian A. Wasserman R. Harris DL. Common Challenges. Slora EJ.
Ewigman BG. Bocain AB. Card Studies for Observational Research in Practice. B t Tex book of Pedia rics and research findings have the possibility of wide community applicability to improve effectiveness. Ann Fam Med. Fagnan LJ. Lindbloom EJ.
John M. Office based research: These include appropriate care of the mother in pregnancy. While it may be difficult to prevent prematurity.
During the neonatal period. In the year the Millennium development goals MDG were set with specific targets for mortality reduction by two-thirds by the year With the inclusion of Afghanistan. Afghanistan ranked 2nd under-5 mortality rate of and Sri Lanka ranked th under-5 mortality rate of 13 in the list of countries Table 1.
The exact burden of prematurity is unknown in the region. The majority The principal causes of neonatal mortality in the region include perinatal asphyxia. Notwithstanding the role of preventive strategies. Given findings that rotavirus infections account for almost a third of all diarrhea deaths.
Prevention and treatment of dehydration is the key for successful management. Many cases of perinatal asphyxia cannot be predicted and hence appropriate facilities for recognition and neonatal resuscitation must be made available in all birthing facilities. Given the high rates of infections in community settings and potential delays in recognition and referral. Emerging evidence from various SAARC countries indicates that the use of cord chlorhexidine may be associated with significant reduction in the risk of neonatal omphalitis and sepsis.
At the very basic level. The basic emphasis of IMNCI training is to recognize pneumonia at an early stage using a classification on the basis of respiratory rate and presence or absence of subcostal recessions and initiation of treatment at first or second level of health care.
The use of surfactant and mechanical ventilation may only be available in larger cities in the private sector hospitals but there is great potential for development of low cost surfactant and equipment. Although there have been remarkable reductions in neonatal tetanus.
While there have been efforts at promoting domiciliary resuscitation in the hands of birth attendants. Hand hygiene. Given the difficulties in referral in some instances. Provision of diet and zinc during the diarrheal episode helps not only to treat current episode but prevent malnutrition as well as respiratory morbidity. Perinatal asphyxia can account for up to half of all newborn deaths in the first week of life and can also be associated with significant neonatal morbidity and developmental disability.
There is also the provision of referral in the event of deterioration or danger signs at presentation. Additional preventive interventions include strengthening of routine immunization. O H P ddressing eterminants and ublic ealth ptions D rural India as well as the use of insulated beds. Khor GL. Trop Med Int Health. Axelson H. Mazumder S. Arifeen SE. Johnson HL. Given the high burden of low birth weight. Rosen HE. Chopra M. Bibliography 3. Bhutta ZA. Taneja S. What works? Interventions for maternal and child undernutrition and survival.
Black RE. An essential element in the quest for targeting the poor. Million Death Study Collaborators. Most people living in rural areas and urban slums live in abysmal conditions and have limited access to quality health care services. Darmstadt GL.
Baqui AH. Kumar R.
Cousens S. Ahmed T. Causes of neonatal and child mortality in India: Hoque DM. Bassani DG. Acuin CS. In addition to poverty and maldistribution of resources. Appropriate targeting. New York. Effectiveness of zinc supplementation plus oral rehydration salts compared with oral rehydration salts alone as a treatment for acute diarrhea in a primary care setting: Akter T. Countdown to decade report Liabsuetrakul T. Bhandari N.
Basic oncepts of hild are development. Community-based validation of assessment of newborn illnesses by trained community health workers in Sylhet district of Bangladesh.
Effect of the Integrated Management of Childhood Illness strategy on childhood mortality and nutrition in a rural area in Bangladesh: Section 2 Care of the Newborn 2. Siddarth Ramji Neonatal Nomenclature: Siddarth Ramji Neonatal Resuscitation: Siddarth Ramji Care of the Normal Newborn: Vikram Datta Parent Counseling: Ranjan Kumar Pejaver Neonatal Hyperbilirubinemia: Rhishikesh Thakre Neonatal Infections: Naveen Jain Neonatal Seizures: Ruchi Nimish Nanavati Respiratory Distress: Ashok Kumar Bleeding Neonate: JN Sharma vip.
This refers to the period of gestation from 22 weeks to 27 weeks of fetal life. Any infant who is up to 28 days of life is termed a newborn or neonate. A neonate who is born before 37 weeks of completed gestation is a preterm neonate. Very Low Birth Weight A neonate with a birth weight of less than 1.
E Gestational Age Related Preterm Neonate o There are several terms that are used in reference to newborn infants and their care.
Achar's Textbook Of Pediatrics
Usually the fetus at this period weighs less than g and has a crown rump length CRL of less than 25 cm. The fetus usually weighs — g and has a CRL of 25 cm up to 35 cm. Early neonatal period: The period from birth up to 7 days of life is the early neonatal period.
Neonatal Nomenclature e of t e Ne ar C 2. Late neonatal period: The period from day 7 up to day 28 of life is the late neonatal period. This section will briefly summarize the commonly used terms in reference to the newborn infant. F Intermediate Fetal Period erm Neonate A neonate born between 37 weeks and 41 weeks of completed gestation is a term neonate. Late Fetal Period This refers to gestations greater than 27 weeks and the fetus usually weighs 1. E t t Tex book of Pedia rics 2. Apgar score is traditionally used to identify birth asphyxia Table 2.
Not all infants born depressed at birth have these associated risk factors. The newborn must be assessed to determine the need for one or more of the following actions in sequence: Birth asphyxia has been defined variously as Apgar score less than 7 at 1 min.
Is the baby crying or breathing? Identified by observing chest rise. Is there a good muscle tone? Identified by noting the posture. It is the most common neonatal emergency in the delivery room. Progression to the next step is initially based on the simultaneous assessment of respiration and heart rate. Progression to the next step occurs only after the successful completion of the preceding step. Approximately 30 seconds are allotted to complete each of the first two steps successfully.
C I A I nitial ssessment and ntervention t Dry all babies soon after birth. Adrenaline 1: The list is provided in Table 2. Assess for the breathing and tone of the baby while drying is being done. Neonates who are vigorous should not be separated from the Initial steps for stabilization dry and provide warmth.
Successful resuscitation in the delivery room needs appropriate equipment. Chest compression requires two personnel—one to continue assisted ventilation and the other to perform chest compressions. A prompt increase in heart rate remains the most sensitive indicator of resuscitation efficacy.
It is indicated to reverse respiratory depression in an infant whose mother has received narcotics within 4 hours of delivery. The dose may be repeated after 3—5 min as indicated. Open airway and position the head. Provide tactile stimulation.
If amniotic fluid is meconium stained and the baby is not vigorous. If one has the expertise. Infant color in the delivery room is a poor marker of hypoxia. The self-inflating bag used for neonates must have a volume between mL and mL.
Do not slap the back or squeeze the rib cage. In vigorous babies. Suctioning mouth should only be restricted to nonvigorous neonates irrespective of the color of the amniotic fluid.
For nonvigorous babies who need resuscitation. Naloxone Figure 2. Assisted ventilation and chest compression are coordinated in a ratio of 30 ventilations to 90 chest compressions 3: Ensure that the mask makes a good seal around the mouth and nose such that when the bag is inflated there is visible chest rise in the infant. In preterms less than 32 weeks. The dose is 0. One must select the correct-sized mask zero size for preterm and size one for term infants for resuscitation.
Reassess the neonate. If the chest does not rise. If the amniotic fluid is meconium stained. The thumb for compression is placed over the lower-third of the sternum. To open the airway. Good response to assisted ventilation after 30 seconds of ventilation is indicated by: If the infant is not breathing even after suction. D Positive pressure ventilation PPV can be provided with bag and mask. Cochrane Database Syst Rev. Use oxygen supplementation cautiously in preterm infants.
Ballard RA. Kattwinkel J. R D When to iscontinue esuscitation ibliography Neonates who needed only initial steps of resuscitation can be provided observational care by monitoring them when roomed-in with their mothers.
Neonates who needed more intensive resuscitative assistance such as assisted ventilation. Yee W. At present there is not sufficient evidence to recommend use of sodium bicarbonate in the delivery room.
Part Neonatal resuscitation: Room air resuscitation or the depressed newborn: Many of these infants would need IV fluids. McDonald SJ. C ey Messages are of he Ne bor Volume Expanders It may be appropriate to consider discontinuing resuscitation if no heart rate is detected for 10 min after birth.
Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. K It is indicated in neonates in shock—poor pulses. Perlman JM. Wyllie J. Rabi Y. Taeusch HW. Rabi D. Middleton P. Gleason GA. When there is delay in passage of meconium.
A female baby may have vaginal discharge and bleeding during that period. The fingertip or thermometer should not be used for checking patency since these may result in injury. Large posterior fontanel or both anterior and posterior communicating is usually abnormal. They usually appear after 2 days and disappear during the first week. The systolic blood pressure will vary from 40 mm Hg to 60 mm Hg and diastolic 25—40 mm Hg.
Natal teeth may rarely be present. Some babies may pass stools once in 2—3 days. Distension of bladder in a male baby suggests posterior urethral valve. They disappear in 2—3 weeks. This enlargement is related to maternal transfer of hormones.
Caput should be differentiated from cephalhematoma. Erythema toxicum are erythematous papular. The length may vary from 47 cm to 52 cm and head circumference 32—35 cm. It is usually noticed after 2 days of birth and disappears after 6—8 weeks.
Nelson Textbook of Pediatrics
Small hemangiomas may be seen over the body surface. When the corner of the mouth is touched. F The average birth weight of babies in India is 2. R t t Tex book of Pedia rics 2. Hypothyroidism should be excluded in babies with constipation. Liver palpable 2—3 cm below the costal margin and palpable spleen tip are normal. There may be molding of the head and caput succedaneum over the presenting part. Usually both testes are in the bottom of the scrotum in term male babies.
Mucosal tags may be seen at the introitus in female babies. It usually does not require treatment. A newborn usually passes urine within 48 hours and meconium during the first 24 hours of life. The infant turns toward the point where the cheek is touched. If there is no distension of abdomen. Enlargement of the breast during first 3—7 days of life is known as mastitis neonatorum and does not require any treatment. A baby may pass frequent yellow-colored watery to semisolid stools during first 3—7 days of life known as transitional stools.
If the testes are not palpable or abnormally placed. If the finger is moved away. Milia are whitish pin head size papular lesions seen over the face due to obstruction to sebaceous glands. If the baby is discharged early. When the dorsum of the hand is touched. There will be abduction and extension of arms with opening of fingers. A bath is delayed until the temperature is stabilized. The baby should be made to wear cap and socks. Newborns are uniquely susceptible to hypothermia because they have a large body surface area.
It is important not to separate the newborn from the mother without a justifiable reason. The reflex may be accompanied by crying. Skin to skin contact with the mother not only prevents hypothermia. The wet linen should be removed and replaced with a dry cloth.
Similar reflex can be elicited in the lower limb by stimulating the sole. F It is a vestibular reflex. A baby should receive 7—8 feeds a day during the first few weeks. The grasp becomes stronger if the head is turned to the opposite side and the stimulating finger is moved toward the fingers. There is no need to instill antibiotic drops into eye except in areas with high incidence of vertically acquired conjunctivitis. Cold extremities with blue or pale color indicate inadequate warmth.
The initial alert period is utilized to start breastfeeds as babies tend to sleep a lot after that. Grasp Reflex n C E ord and ye are The umbilical stump should be cleaned with spirit and kept dry. Persistence of grasp after 3 months of age may indicate cerebral palsy. The pregnant mother should be explained the benefits of breastfeeding and the family members are encouraged to support her. The fingers close and grasp the object.
They disappear when voluntary control of feeding is achieved.
It is better if baby bath is not given in hospital for fear of cross infection. Kangaroo care position is the most ideal. K Management Breastfeeding should be initiated soon after birth and exclusive breastfeeding is advised till 6 months of age in normal term babies. Health workers caring for newborns should learn the signs of good attachment. They are dependent on caregivers to keep them warm and dry. They are decreased or absent when there is neurological depression.
The baby should be free of illness. Local application of antiseptics is not required. This is followed by flexion and adduction of arms. Mother should be informed about danger signs and the need to get medical advice as and when they are observed. The infant should be received in prewarmed sterile linen and should be dried thoroughly from head to foot. It is exaggerated when there is cerebral irritation caused by hypoxia. It is decreased with sedation.
Some of the danger signs are given in Table 2. The eyes should be cleaned with sterile wet cotton. Parthasarathy A. Nair MK. Babies should be followed up and anthropometry recorded in a growth chart. The growth and development should be evaluated monthly during the first few months and 3-monthly thereafter.
Growth and development should be monitored during follow-up. Echenwald EC. Cloherty JP. Behrman RE. Jaypee Brothers. Breastfeeding is initiated as soon as possible. Manual of Neonatal care. Jenson HB Eds. WB Saunders.
Initial immunization should be given before discharge. Some Problems of the Early Years and their Treatment. Gleason CA. Illingworth RS. Bhave SY Eds. Bhat BV. The Normal Child. Neonatal care.
Menon PS. Stark AR Eds. All babies should receive vitamin K prophylaxis. Elsevier Saunders. Nelson Textbook of Pediatrics. Lippincott Williams and Wilkins. Temperature control and prevention of hypothermia is vital.
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The severity of respiratory distress RD can be monitored using the respiratory distress score Table 2. Table 2. These are infants who require additional support such as oxygen. Following history should be elicited to determine nature of illness. IV fluids. Important signs and their utility are summarized below.
Pallor Pallor may indicate anemia due to blood loss or hemolysis. Hyperthermia is less common.Wasserman RC. Marx Pages. The newborn must be assessed to determine the need for one or more of the following actions in sequence: This is calculated as shown below: Findings of a study on the compliance of anti-tubercular therapy done in Latin America may not be applicable in Indian settings due to various social.
Except for a solitary chapter by Spittell, the English literature forces the clinician to review scattered, multiple sources when faced with a clinical problem. Costochondral beading is seen in rickets broad and dome shaped. In this era of quick communication and fast travel, the benefits of a newly discovered drug has started reaching our country within few years rather than decades. In this discussion. The pulse is felt mainly over the radial artery at the wrist.
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