Health and Religion

Cough syrups for children

2025-10-30T11:05:00.000+05:30

See vdo in हिंदी Hindi

https://youtube.com/watch?v=m_CE-VN_ZwE&si=6KIsX25-HEQFrBaU

Procedure room Temperature for infants

2019-04-09T13:47:00.002+05:30

My publications

https://scholar.google.co.in/citations?user=GNMF2CQAAAAJ&hl=en

Procedure room Temperature for infants

Some infants (birth to 12 months of age) develop complications soon after surgeries or CT Scan/ USG etc.

Therefore, Infants if kept in an AC room below 25° C without (less) clothes can develop life-threatening Hypothermia complications including shock, Respiratory distress- bronchospasm, Grunting, Convulsion, etc.

When infants are to be Procedured upon pl. keep the temp of the room of OT, USG room, CT area, MRI area, audiometry, etc between 28-30° C and thereafter only receive the infant for a procedure.

Inj. Paracetamol (Acetaminophen) in Children

2019-04-09T13:42:00.002+05:30

Inj. Paracetamol in Children

In Serious cases it is used as injection 5mg/kg/dose.

However, it is best avoided; as severe hypothermia reaction (cold skin and perspiration leading to hypovolemia, hyponatremia), shock and death has been associated within 3 hours of using inj. PCM in seriously ill children.

The death is presumed to be because of serious illness of the child; however paracetamol can be a contributing factor.

In children it should be used always as diluted by infusion or preferably not to be used at all.

It seems that in some cases high grade fever is not as harmful as inj. Paracetamol.

PEDIATRICS Dept PUBLICATIONS Bhavnagar

2018-04-08T10:44:00.001+05:30

https://scholar.google.co.in/citations?user=GNMF2CQAAAAJ&hl=en

http://pediatricsbhavnagar.blogspot.in/2018/04/pediatrics-dept-publications.html

Since 2015

New added in 2020

8] IgM-Rich Immunoglobin for Treating Bacterial Sepsis in VLBW Preterm Neonates Sonal Vijay Jindal, Jayendra Ratilal Gohil https://www.perinatology.in/efficacy-of-igm-rich-immunoglobin-for-treating-bacterial-sepsis-in-very-low-birth-weight-preterm-neonates

full text pdf googledrive full text pdf tinyurl IgM rich Gohil

7] Paracetamol vs Ibuprofen in Hemodynamically Significant Patent Ductus Arteriosus (HsPDA) in Preterms: A Randomized Controlled Trial Hinal A Sinol, Alpa N Parekh, Jayendra R Gohil

6] Adrenaline and Dexamethasone, vs Adrenaline and Fluticasone, vs Adrenaline alone in Bronchiolitis: an RCT Jayendra R Gohil, Atul M. Sheladiya

5] Diethylcarbamazine (DEC) in Relapse Cases of Nephrotic Syndrome in Filarial Endemic Region: A Case Series Jayendra R Gohil, Tanmay P Vagh

4] To Study the Anthropometric Measurements of the Neonates between 28-42 Weeks Gestational Age at Bhavnagar, Gujarat Shreya A Patel, Jayendra R Gohil

3] Hypophosphatemia in Refeeding Syndrome in Intrauterine Growth Restricted IUGR Neonates: a Prospective Observational Study Varunashree Chaudhary, Jayendra R. Gohil

http://www.journalajpr.com/index.php/AJPR/issue/view/4558 3 ARTICLES IN THIS ISSUE

2] https://shar.es/a39TNP Ratna Bhojak, Jayendra Gohil Efficacy of Once a Month Single Dose Intravenous (Deferoxamine) versus Daily Oral (Deferasirox) Iron Chelator in Thalassemia Major: An Open Label Randomized Parallel Group Active Control Interventional Trial

1] Heated, Humidified High-Flow Nasal Cannula Versus Nasal CPAP for Respiratory Support in Neonates: a prospective Study from Bhavnagar, Gujarat Zala DD, Gohil JR.

New added in May 2019

# Gohil JR. Adrenaline before Unconventional Therapy for Status Asthamaticus. Indian J Crit Care Med 2019;23(10):492. doi.org/10.5005/jp-journals-10071-23273

Refractory Status Asthmaticus: A Case for Unconventional Therapies, article by Vohra R has mentioned survival of a child after using ECMO and isoflurane when other treatments were not effective.1

History of food ingestion prior to onset of status is not mentioned as there are foods like dairy, nuts, seafood, eggs, and pollution and color, that may precipitate an acute episode.

In the treatment however, inj. adrenaline and inj. hydrocortisone were not used; although intravenous methylprednisolone (2 mg/kg) was used. Intramuscular adrenaline is having better absorption and quicker effects than subcutaneous route.2

Ipratropium is an atropine like drug and leads to thickening of secretions and mucus plugging and have to be removed by bronchoscopy lavage.

Injections of adrenaline and hydrocortisone should be administered before resorting to ECMO and isoflurane.

Re f erenc es

1. Vohra R, Sachdev A, Gupta D, Gupta N, Gupta S. Refractory status asthmaticus: A case for unconventional therapies. Indian J Crit Care Med 2018;22(10):749–752.

2. Gohil J, Agarwal TS. Anaphylaxis and Angioedema: A of ABC means Adrenaline First: Airway comes Later. J Asso Physicians India. 2018;66(10):76.

Pediatrics dept DiSSERTATION THESIS Bhavnagar

2018-04-07T14:23:00.001+05:30

Pediatrics dept Bhavnagar Dissertation List

http://pediatricsbhavnagar.blogspot.in/

PAPERS published 2018

2018-04-06T08:33:00.000+05:30

Screening of school children for Attention Deficit Hyperactivity Disorder using Vanderbilt ADHD Diagnostic Teacher Rating Scale
Jayendra R Gohil, Mrigank N Gupta, Shruti U Patel, Shreya A Patel. Pediatr Education Res.2018;6(2 MayAug):116-119.* Rcvd May 29, 2018. Accepted Jun 22, 2018 http://rfppl.co.in/current_issue.php?jid=22

Kangaroo Mother Care in Preterm Baby Receiving Assisted Respiratory Support (CPAP): A Case-Control Trial. Pranav H Punasanvala, Alpa N Parekh, Jayendra R Gohil, Shridhar Pujari. Int J Contemp Pediatr. 2018;5 May(3):1008-12.
http://www.ijpediatrics.com/index.php/ijcp/article/view/1473
http://dx.doi.org/10.18203/2349-3291.ijcp20181531

Anaphylaxis and Angioedema: A of ABC means Adrenaline First: Airway comes Later. Gohil JR, Agarwal TS. J Assoc Physicians India. 2018 Oct;66:97..

Levetiracetam Adverse reaction : Pancytopenia. Gohil JR, Agarwal TS. J Pediatr Neurosci 2018;13(1):116-7. http://www.pediatricneurosciences.com/article.asp?issn=1817-1745;year=2018;volume=13;issue=1;spage=116;epage=117;aulast=Gohil

Cardio-toxicity associated with Midazolam in a patient with Diphtheria. Gohil J R, Jindal Sonal V. Current Drug Safety. 2019;14(1):57-59. doi.org/10.2174/1574886313666181105122154

Cord Blood Albumin as A Predictor of Neonatal Hyperbilirubinemia: A Prospective Open Label Study. HR Chauhan, AN Parekh, JR Gohil. National J Integrated Research in Medicine 2018;8 (5):41-43. http://www.nicpdjournals.com/?mno=284690

Pediatrics dept Bhavnagar Dissertation List

http://pediatricsbhavnagar.blogspot.in/

Papers 2017

2017-07-13T17:43:00.002+05:30

Intrathechal vs. Intramuscular Human Tetanus Immunoglobulin in Pediatric Tetanus: A Retrospective Study

ABSTRACT

Objective To evaluate the effect of intrathecal vs. intramuscular tetanus immunoglobulin therapy on hospital stay and mortality in pediatric tetanus patients admitted to a tertiary care hospital.

Methods Retrospective analysis of hospital records of tetanus cases to the pediatric ward during two year period from march 2012 to february 2014 was done. All patients were managed as per pre-existing unit protocol. Group A received Human tetanus immunoglobulin (TIG) 250 unit via the Intrathecal route preceded by IV ketamine (1 mg/kg) for proper relaxation to ease the procedure and the group B was given TIG 750 unit via intramuscular route. Whether to give TIG by Intrathecal or intramuscular route was decided according to the treating unit’s protocol. Information regarding– sex, age, immunization status, mode of infection, grade of tetanus, outcome and hospital stay was recorded in the two groups.

Results After excluding Neonatal tetanus cases there were 40 patients aged between 1 to 12 years during the two year study period. Out of 40, group A had 15 patients (intrathecal route) and group B had 25 (intramuscular route). Mortality and hospital stay was found to be numerically less, but statistically not significant, in group A (26.67%; 12.4 ±2.25days) as compared to group B (28%:15.4 ± 1.69 days).

Conclusion We found no significant difference between intrathecal immunoglobulin and intramuscular immunoglobulin therapy in management of pediatric tetanus in terms of mortality and hospital stay. An unintended result was that ketamine can be safely used as a sedative in tetanus patients for lumbar puncture to give intrathecal antitetanus immunoglobulin.

http://rfppl.co.in/online_first.php?jid=22
Pediatric Education Research 2017:5(2):57-60.

My Clock

2017-01-06T15:16:00.004+05:30

timeanddate.com

Papers Published 2016

2016-09-13T17:23:00.005+05:30

The effects of Music Therapy on Vital signs, Weight, and Well being ofPremature infants

Mehta Rajeshri R, Gohil Jayendra R, Patel Rhushita M, Agarwal Tushar

Indian Journal of Maternal fetal Neonatal Medicine. 2016(2,07-12);3:73-9.

Redflower publication PLtd

http://www.rfppl.co.in/view_abstract.php?jid=56&art_id=3828

http://dx.doi.org/10.21088/ijmfnm.2347.999X.3216.32016/12

Correlation of blood culture results with the sepsis score and sepsis screen in the diagnosis of early-onset neonatal septicemia

Hassan Heena R, Gohil Jayendra R, Desai Rihan, Mehta Rajeshri R, Chaudhary Varunashree P.

2016/9 Journal of Clinical Neonatology Vol 5;3:193-8.

dx.doi.org/10.4103/2249-4847.191263

Saudi Neonatology Society

Headband Sign on MRI: An unusual finding of Scurvy in a 5y child described first time

http://www.pediatricneurosciences.com/text.asp?2016/11/4/355/199484
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5314856/

Phenobarbital, Phenytoin, Lorazepam: Comparative Efficacy of for the Treatment of Neonatal Seizures: An RCT

2015-12-01T11:44:00.000+05:30

http://www.jcnonweb.com/article.asp?issn=2249-4847;year=2015;volume=4;issue=4;spage=232;epage=236;aulast=Solanki

Ketamine: Efficacy and safety of injectable in pediatric ward procedure in 6 month to 12 year at tertiary care hospital

2015-12-01T11:41:00.004+05:30

Journal of Pediatric Sciences. 2015;7:e243. http://dx.doi.org/10.17334/jps.99464

Cornelia de Lange Syndrome - CDLS in a Neonate

2015-01-18T17:19:00.002+05:30

https://drive.google.com/file/d/0B2IaS_Wskr_JbGgydDVFT053MWM/view?usp=sharing

Parotitis (Neonatal, Suppurative) and Shoulder Arthritis; Bacterial Infection in Children with PEM

2014-12-25T12:03:00.000+05:30

Neonatal, Suppurative Parotitis and Shoulder Arthritis following Nasal prong and Orogastric tube

https://drive.google.com/file/d/0B2IaS_Wskr_JMkpBX3JkSjJXOVk/view?usp=sharing

Published at Pediatric Education Research Journal 2019;7(4):35-38.

https://rfppl.co.in/subscription/upload_pdf/Jayendra%20R%20Gohil%205_10264.pdf

Jayendra R Gohil, Monil B Shah, Atul M Sheladiya

GMC, & Sir T G Hospital, Bhavnagar

Bacterial Infection in Children with PEM Grade

III & IV at Tertiary Care Hospital from INDIA

Dholakia P J*, Parekh Z R**, Gohil J R **, Gosai M **, Solanki D I

https://drive.google.com/open?id=0B2IaS_Wskr_JWVhNVUJ2M0J4WmM

MY PUBMED LIST

2014-03-29T03:06:00.000+05:30

14 Pubmed CITATIONS for GOHIL JAYENDRA R

Total 21

View my collection, "My Bibliography" from NCBI

Pediatrics dept DiSSERTATION THESIS Bhavnagar

2014-02-28T22:02:00.004+05:30

Pediatrics dept Bhavnagar Dissertation List
http://pediatricsbhavnagar.blogspot.in/

OLDER POSTS

http://health-religion.blogspot.in/2012/09/BF-counselling-for-retracted-nipples.html

http://health-religion.blogspot.in/2012/08/goals-are-always-achieved.html

DROPSY: Sanguinarine, Hydroxybutyrate Dehydrogenase and Fatigue in Epidemic Dropsy: A Retrospective Study of an Outbreak and its Control from Gujarat, India

2014-02-27T22:09:00.002+05:30

Dept of Pediatrics and Medicine, BJMC & CH Ahmedabad- 380016
Prof. Jayendra R Gohil, Dr. Bankim D Mankad, Dr. Bipin K Amin

https://drive.google.com/file/d/1XwH8-ASdzfx-wNVFYArMx-UO4n0H40WX/view

https://www.webmedcentral.com/article_view/2118

Diphtheria Photograph

2014-02-27T21:53:00.005+05:30

Prof. Jayendra R Gohil, Dr. Bhavesh A Shah, Dr. Alpa N Parekh
Pediatrics dept, GMC, STGH, Bhavnagar- 364002

http://www.webmedcentral.com/wmcpdf/Article_WMC002594.pdf

Bhavnagar Diphtheria Incidence from PED dep data
Expiry shown as -x* where known.


2005	68
06	56
07	62
08	59
09	75
10	56
11	34-9*
12	19-5*
13	12-2*
2014	14-4*

2015 8-4*

2016

Montelukast vs Budesonide as a First Line Preventive Therapy in Mild Persistent Asthma in 2 to 18 y

2014-02-27T09:20:00.000+05:30

Monil Bharat Shah,

Jayendra Gohil,

Swati Khapekar,

Jigna Dave

Pediatrics and Respiratory dept, GMC and STG Hospital, Bhavnagar, India

IJP online Feb 21, 2014 http://link.springer.com/article/10.1007/s12098-013-1334-y

PMID:
24553973

Abstract

Objectives

To compare the efficacy of oral Montelukast and inhaled Budesonide as a first line preventive therapy in mild persistent asthma in age group 2–18 y.

Methods

This prospective randomized controlled clinical study was conducted for 12 wk. 60 patients of mild persistent asthma aged 2 to 18 y were randomly allocated to either oral Montelukast (n = 60) or inhaled Budesonide (n = 60) group. Outcomes measured were improvement in peak expiratory flow rate (PEFR), forced expiratory volume 1 s/ forced vital capacity (FEV1/FVC), day and night time symptoms, frequency of exacerbations and need to change medications.

Results

There was significant improvement in PEFR, FEV1/FVC, day time and night time symptoms and frequency of exacerbations in both groups. However, more significant improvement in FEV1/FVC (CI 95 %, p = 0.029) and day time symptoms (CI 95 %, p = 0.002) was seen in Budesonide group compared to Montelukast group.

Conclusions

The present study suggests that oral Montelukast is not inferior to Budesonide in treatment of mild persistent asthma in 2 to 18 y children in terms of control of symptoms and improvement in pulmonary function tests over a 12 wk period. However, there was more significant improvement in day time symptoms, more significant increase in FEV1/FVC ratio and less exacerbation in patients receiving Budesonide compared to those receiving Montelukast. However, side effects due to long term use of steroids such as growth stunting and bone osteopenia should also be considered before recommending.

Trial registered at CTRI no. REF/2012/09/004035

BIRTH ASPHYXIA: REVIEW 2014 JAN

2014-02-06T21:23:00.000+05:30

BIRTH ASPHYXIA Review Article

Prof Jayendra R Gohil, MD, Professor & head

Dr Heena Hasan, MBBS, Resident

Pediatrics dept, Govt. Medical College & Sir TG Hospital, Bhavnagar- 364002
http://rfppl.co.in/subscription/upload_pdf/JAYENDERA%20GOHIL_1314.pdf

Full Text Link https://drive.google.com/file/d/0B2IaS_Wskr_JOG9ISE5UaHd5U2s/view?usp=sharing

Font changes are unintentional.......

ABSTRACT

Birth asphyxia is an important cause of acute neurologic injury, occurring in 2 to 3 cases per 1000 term live births in developed countries, with a higher incidence in less developed countries. Birth asphyxia related neonatal mortality and morbidity including long-term neuro-developmental sequele was seen in 25%-60% of survivors. It is estimated that around 23% perinatal deaths are due to birth asphyxia, with a large proportion of stillbirths. Asphyxia should not be confused with hypoxic ischemic encephalopathy (HIE) or cerebral palsy (CP) since not all asphyxiated neonates develop HIE or CP and there are other causes for the same. In this article there is description of definitions, aetiologies, pathophysiology, clinical features, basic and recent investigations, older and newer treatment of birth asphyxia.

Conclusion: Although there is no specific treatment for birth asphyxia only supportive treatment (fluid and electrolytes balance, oxygenation and ventilation etc.) to prevent the complications and primary preventive measures (electronic fetal heart monitoring, training to birth attendants, home based newborn care) are helpful.
In the developed world, for the HIE, hypothermia has been the only treatment that has worked somewhat (8 -18%). The preferred cooling is whole body with a heart-lung bypass or ECMO; since that is rarely available, external whole body or external head cooling is the next best option. Prevention of reperfusion injury by early (within 6 hours) antioxidant therapy seems to hold the promise for future and should be studied.

Introduction:

Birth asphyxia is a major cause of neonatal deaths, especially in rural India and in urban places where birth attendants trained in resuscitation are not available immediately. It also results into severe neurological long term morbidity; hardly any specific treatment is available. Perinataly asphyxiated newborns born in absence of trained manpower results in higher number of stillbirths. Prevention of the primary events and complications seem to be the best strategy at present.

Definition of birth asphyxia designed for use in hospital based settings require evaluation of umbilical cord pH, Apgar scores, neurologic clinical status, and markers of multisystem organ function¹ and are not feasible for community settings². The majority of neonatal deaths occur in the home without medical supervision; community-based definitions must rely on data gathered from verbal autopsy methods and use more general symptom- and sign-based algorithms. For example, the National Neonatology Forum of India has defined birth asphyxia as “gasping and ineffective breathing or lack of breathing at 1 minute after birth.”³ Such sign-based definitions are not, however, implemented consistently, and varying study-specific definitions may affect estimation of the proportion of neonatal deaths attributed to birth asphyxia.

Regarding the definition according to American College of Obstetricians and Gynaecologists and the American Academy of Paediatrics, a neonate is labelled to be asphyxiated if the following conditions are fulfilled: (1) Umbilical cord arterial pH < 7; (2) Apgar score of 0 to 3 for longer than 5 minutes; (3) Neurological manifestations (e.g., seizures, coma, or hypotonia); and (4) Multisystem organ dysfunction, e.g., cardiovascular, gastrointestinal, haematological, pulmonary, or renal system.⁴

Outcome of birth asphyxia depends on Apgar score at 5 minutes, heart rate at 90 seconds, time to first breath, duration of resuscitation, arterial blood gases and acid –base status at 10, and 30 minutes of age.⁵ It is measured as short term (early) and long-term outcome. The early outcome is either death/or presence of hypoxic ischemic encephalopathy (HIE) grade I, II or III, according to Sarnat staging.⁶

Perinatal asphyxia refers to a condition during the first and second stage of labour in which impaired gas exchange leads to fetal hypoxemia and hypercarbia. It is identified by fetal acidosis as measured in umbilical arterial blood.⁷

Perinatal hypoxia, ischemia, and asphyxia. These pathophyslogical terms describe respectively, lack of oxygen, blood flow, and gas exchanges to the fetus or newborn. These terms should be reserved for circumstances when there are rigorous prenatal, perinatal, and postnatal data to support their use.⁷

Perinatal /neonatal depression is the preferred clinical descriptive term (over Birth Asphyxia by ACOG, but not in vogue) that pertains to the condition of the infant on physical examination in immediate postnatal period (i.e., in the first hour after birth). The clinical features of infants with these conditions include depressed mental status, muscle hypotonia and possibly disturbance in spontaneous respiration and cardiovascular function. These terms make no association with the prenatal or later postnatal condition (i.e., beyond the first hour) condition, physical exam, laboratory tests, imaging studies or electroencephalograms. After the first hour or so life, neonatal encephalopathy is the preferred descriptive terms for infants with abnormal mental status and associated findings.⁷

Neonatal encephalopathy is a clinical and not an etiologic term that describes an abnormal neurobehavioral state consists of decreased level of consciousness and usually the other signs of brain stem and/or motor dysfunction. It does not imply a specific aetiology, nor does it imply irreversible neurological injury as it may be caused by such reversible conditions as maternal medications or hypoglycemia.⁷

Hypoxic ischemic encephalopathy is a term that encephalopathy as described above with objective data to support a hypoxic ischemic mechanism as the underlying cause for the encephalopathy.⁷

Hypoxic ischemic brain injury refers to neuropathology attributable to hypoxia and/or as ischemia as evidence by biochemical (such as creatine kinase brain bound [CK-BB] ,elecrtophyiologic (EEG), neuoroimaging (head ultrasonography), MRI, CT or pathological (post-mortem) abnormalities.⁷

Neonatal Encephalopathy or Neonatal neurological syndrome⁸

- term infant <7 at="" days="" o:p="" onset="">

- depressed consciousness level

- abdominal tone and power

- feeding difficulty

- seizure
expired link=<http://www.rfppl.com/current_issue.php?jid=56>

BACTERIAL INFECTION in CHILDREN with PEM GRADE III & IV at SirTG HOSPITAL, BHAVNAGAR, INDIA

2014-02-03T01:21:00.003+05:30

Dholakia P J*, Parekh Z R**, Gohil J R **, Gosai M **, Solanki D I **
INTERNATIONAL JOURNAL OF MEDICAL AND APPLIED SCIENCES 2013; VOL2issue4:147-51.
Full text pdf
http://earthjournals.org/ijmas_228.pdf

ABSTRACT

Protein energy malnutrition (PEM) has been identified as a major health and nutrition problem in India. It is an important cause of childhood morbidity and mortality. The incidence of PEM in India in Preschool age is 3-4%. These children’s are more prone for infections. Bacterial infection & PEM is deadly combination for child.
Methods: Therefore we conducted prospective study for one year period. Patients having PEM grade III and grade IV, according to IAP classification are included in study. Blood culture, urine culture and stool culture were sent on day 1, along with routine investigations and data was analyzed.
Results: In our series of 74 patients, 9.5% are blood culture positive. Out of these, 6.8% are gram positive and 1.7% is gram negative organism. Urine cultures were positive in 5.4% of cases. Out of these 3.1% are gram negative organisms. Only 1% had stool culture positive. Anemia present in 78.9% of patients. Pneumonia was being diagnosed in 35.1% of patients, and diarrhea in 14.9% of patients. Mortality rates 5.4, of these 3.05% are in PEM grade III.
Conclusion: In the patients studied- All patients with PEM grade III & grade IV needs to be investigated for blood culture and urine culture. Stool culture is not necessary in PEM child. Preferential coverage of gram positive organisms while selecting antibiotic is necessary. Pneumonia is most common in child with PEM grade III.

Key Words : Bacterial Infection, Culture, PEM grade III &IV

Early Detection of Subclinical Diphtheritic Myocarditis by Aspartate Aminotransferase -AST- or Serum Glutamic Oxaloacetic Transaminase (SGOT) Estimation at SirTGH, Bhavnagar, India

2014-02-03T01:11:00.001+05:30

http://www.scopemed.org/?jft=83&ft=83-1383282606
Pooja J. Dholakia, Zankhana Parekh, Jayendra R. Gohil, Dhaval I. Solanki.
From Pediatrics dept, GMC, Bhavnagar
Full text pdf
http://www.scopemed.org/fulltextpdf.php?mno=46746

Abstracts
Background & objectives: Diphtheria is endemic in India. Almost 50 - 60% of diphtheria deaths are due to myocarditis. Incidence of subclinical myocarditis is 68%. Aspartate Aminotransferase -AST- or Serum Glutamic Oxaloacetic Transaminase (SGOT) level can be used as marker of extent of myocardial damage during the course of diphtheria[3-7]. We therefore conducted study to detect early myocarditis due to diphtheria by measuring SGOT level.
Methods: This is a prospective study of 55 patients admitted over a 6 months period in a tertiary care hospital. Patients, from whom Corynebacterium diphtheria was isolated in throat swab culture, were enrolled in study. The clinical parameters, ECG and SGOT level were estimated on admission. All data were collected and statistical analyzed.
Results: The SGOT level was high in 65.5% (36/55) of patients. The clinical myocarditis was found in 25.8 % (6/55) patients. In 91.6% (33/36) cases of myocarditis, ECG did not reveal any abnormality, but definite elevations of the enzyme levels were noticed. The mean ± SD age of children in our study was 6.6 yr ± 3 (range 1-13) years. SGOT level was high in 36 cases; out of them 30 cases (83.3%) having duration of illness less than 7 days. Out of 6 expired cases 4 patients (66.7%) had raised SGOT level. We noticed 83.3% (5/6) cases expired due to diphtheritic myocarditis had abnormal leukocyte count (p 0.01).
Interpretation & Conclusion: We concluded elevated SGOT levels had high sensitivity and a negative predictive value to detect subclinical diphtheritic myocarditis.
Abnormal (high or low) total leukocyte count had poor prognostic value.

Key Words: Diphtheritic Myocarditis, Leukocyte count, Serum Glutamic Oxaloacetic Transaminase, SGOT

Breast Feeding -BF- Counselling for Retracted Nipples

2012-09-30T19:33:00.001+05:30

Jayendra R Gohil, Prof. MD.
Retracted or inverted nipple is widely believed to cause breast feeding inadequacy. This type of nipple is caused by short ducts and fibrous bands pulling and binding or tethering the areola to subcutaneous tissue. A retracted nipple can be pulled back but inverted cannot be. An article in Indian Pediatrics mentioned retracted nipples, as an anomaly hindering breast feeding, and a novel treatment- sucking by husband is mentioned. A ‘syringing’ suction treatment has also been devised [J Human Lactation]. These treatments are offered before and after delivery.

Breast feeding is made possible by holding the baby to a proper ‘position’; resulting in good

latching & attachment, followed by coordinated reflex actions by baby.

As per definition and as a fact a baby latches onto areola and not nipple. So a small nipple or nipple retraction does not come in the way of a baby’s ability to latch onto areola to breast-feed. However, if baby has small mouth (preterm) or small mandible (micrognathia), and nipple is large(r) it may choke the baby.

This has been corroborated in IMNCI, WHO manual where no mention is made to treat, care or even recognize flat, retracted or inverted nipples; rather they have placed emphasis on Breast engorgement and 'improper positioning’ as cause of breast-milk ‘not coming’ or ‘baby not sucking’.
The ‘Navajat Shishu Suraksha Karyakram’ (NSSK- Hindi) from health department of India Government, Delhi and similar Basic Newborn Care and Resuscitation Program of Indian Academy of Pediatrics, Bombay mentions that flat or short nipple does not cause breastfeeding problems; however inverted nipple should be recognized and mother assisted antenatally.

Proper counseling to mother after delivery should be- ‘Do not worry about (small) size of nipples, baby anyway is going to take areola in mouth and draw milk out from ducts behind nipples, with the help of proper positioning. Only nipple sucking may cause sore nipples and breast feeding problem. Before delivery, treatment counselling may be advised with the reassurance that her retracted nipples, even if uncorrected by the time of delivery, shall not lead to any breast feeding problems.

By telling mother (her nipple is defective), leads to anxiety; less hormone (oxytocin) secretion and BF failure. So if a baby is not breastfeeding due to insufficient milk or due to some problem, then certainly the problem is not the retracted nipple, but it lies in most of the cases in 'incorrect position' or 'faulty beliefs or assumptions'.

A well conducted RCT in BMJ even recommends to abandon the practice of diagnosis of flat/retracted nipples, to avoid such anxiety.!!

Goals Are Always Achieved

2012-08-11T01:27:00.000+05:30

Jayendra R Gohil

I am writing this from India.... after a report of a flamboyant owner's company performing poorly in air-line sector. What has happened is blamed on global factors, gas prices, cheap fares etc. However.......

What is a goal. ? For a company- customer, shareholder, employee service and a higher purpose eg to make life easier or to free sick from illness or to prevent illness are generally the stated goals as part of mission statements.

I will tell you a story of building a bridge. After 1 year the bridge was washed away during floods with loss of lives and money and time. Still I say the goal was achieved; you ask how the goal of building a bridge to serve community for next 75 years was achieved when clearly it was washed away in first monsoon. But my dear, the goal was achieved and how, because the stated public goal was not the goal the officers and builders had in mind. Their hidden agenda (goal) was to make money and that they achieved. So the hidden goal or agenda was not aligned with the publicly stated goal. But the goal that was hidden as their agenda and was aligned to their true feelings and desires was achieved. So it is, so true everywhere.

You build an airline to ferry passengers safely and reasonably or is it to mingle with beautiful ladies.? You build a sports team to get an eye-candy actress or to advertise your brand or to really promote sports.? Why a political party at centre did not last long after defeating a very strong lady ? Because, the goal was not to give a better life to people of India for the next 5 years. Agenda was just to defeat her and thereafter; after defeating her, nobody knew what to do; this is simplifying it a lot, but you will get my point. In tennis the woman player really wants to excel at the game or just wants to be famous.? Getting both is not a bad thing and is in fact a side benefit one must enjoy and live with or learn to live with. But when getting famous is the only agenda then the game suffers. In hockey and other sports many times the agenda is not to be the champion but simply to defeat the Neighboring country team; and having done that players do say – we feel we are on top of world, we feel as if we have won the Cup/ Trophy. No wonder then that subsequent performances are dismal.

It is true for students too. Is he enrolling to the college to pass the years away or to benefit him, his family and the society he lives in. If former then he may pass out from college even as a doctor but he will not excel at being a doctor and may be miserable.

It is true in starting families too. Do you marry to create a strong family to carry onto next generation; or do you marry to marry a beautiful (fair skin in India) girl only. Then strong family will not be there and once the skin-deep beauty goes away misery will be there for all.

As I said earlier having both goals (goal and agenda or goal and side benefit) is not a bad thing nor is it impossible. But it should have been your inner soul’s agenda aligned to publicly stated goal from the beginning. However in some cases you can correct your course and align your agenda and goal midway through a project too.

If the goal is getting Osama only, then terrorism will not be wiped out. If the goal is to wipe terrorism then it may be controlled. If the goal is better life for people of Taliban areas then only terrorism will be truly wiped out. If the goal is to win election on terror propaganda then terror will not go away.

Next time your road comes to an end at a river bank, think of building a bridge; or building a bridge and make reasonable amount of money due to you, but do not think of only making money.!!
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Dr Jayendra R Gohil, Professor of Pediatrics, Madhavjyot, Bhavnagar- 364002 India