Acute Gastroenteritis

This year’s winter is definitely more unique than ever. Temperatures in high 50’s and no snow on Christmas has altered winter break plans as well as the cycle for the most common pediatric condition such as acute gastroenteritis (AGE), commonly known as “stomach flu”.

AGE usually presents with vomiting, diarrhea, fever and abdominal cramping pain. In medical literature, diarrhea is defined as a passage of three or more loose or watery stools per day (or more frequent passages of stool than is normal for the individual). Frequent passage of formed stools is not diarrhea, nor is passing of pasty stool by a breastfed infant.

Vomiting is usually the first of presenting symptoms, and more commonly than not, it occurs in the middle of the night. After emesis subsides, diarrhea begins. Ongoing fluid and electrolyte losses lead to dehydration in children which is the major cause of morbidity in children with acute gastroenteritis. Continue reading “Acute Gastroenteritis”

HPV Vaccines

Gardasil® or HPV vaccine has been gracing front lines for some time now.  Over the years I have been asked numerous times about the risk and benefits of this vaccine for male and female adolescents.  In this post, I would like to provide the most current information to allow adolescents and their parents to make an educated decision.

Human Papillomavirus (HPV) Vaccine was developed to protect our growing preteen and teen population from most of the cancers caused by HPV infection. HPV is a common virus that affects thousands of men and women yearly. Most of the time, the body naturally fights off HPV before it causes any problems.

Human Papillomavirus

In cases when the body is unable to fight off the virus, HPV causes a number of health problems, like cancers and genital warts. HPV is central to the development of cervical neoplasia (precancerous) and can be detected in 99.7% of cervical cancer.  Women with cervical cancer are usually asymptomatic in early stages, with symptoms usually presenting themselves when cancer has metastasized.  PAP smear is a universal screening that is used to screen women for cervical cancer.  For that reason alone, all women 18 years and older should have annual gynecological exam. Continue reading “HPV Vaccines”

Ear infections

Ear infections are the most common clinical complain in the pediatrician office.  Most cases are seen in children ages 6 month to 24 month of age. The prevalence of the ear infections decreases as the child matures and are infrequent in school-age children, adolescents, and adults.

The biggest culprit of ear infections is usually a common cold. To understand better how a common cold leads to an ear infection, let us go back to basic physiology. Our nose and throat connected with middle ear through the Eustachian tube.   The Eustachian tube is positioned at the angle to prevent reflex of the secretions from the nose and throat getting into the middle ear.

Eustachian tube - difference between normal middle ear and the one with Otitis media
Eustachian tube – difference between normal middle ear and the one with Otitis media

The other responsibility of the Eustachian tube is to keep the air pressure inside the middle are same as outside. Normally middle ear compartment is filled with air only, but when patient has a cold it begins to accumulate fluid.  During viral process an increase amount of mucus produced inside in the nose. The viral particles cause inflammation inside the nose and later in the Eustachian tube.

The obstruction of the Eustachian tube in turn causes poor ventilation and leads to the accumulation of secretions in the middle ear. This fluid is sterile, but nasal secretions are not and when the Eustachian tube temporarily relaxed virus particles/bacterial particles get in.  Microbial growth inside the secretions in the middle ear, cause the clinical symptoms of the ear infection.

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Vitamin K Deficiency Bleeding in Newborns

In recent years, I have noticed increased hesitancy and even plain refusal from new parents to allow their babies to receive Vitamin K intramuscular injection at birth. This anxiety has initially started in 1992, after a study done by Golding et. al. have shown 2.65-fold increase in leukemia associated with intramuscular Vitamin K injection. The finding has not been replicated by any other subsequent studies. Unfortunately, much public anxiety remains to this day.

Newborn infants that do not receive Vitamin K at birth have increased risk of developing Vitamin K Deficiency Bleeding (VKDB). VKDB can be further categorized into 3 groups based on the time of presentation as early, classical or late.

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Puberty, Adolescents and Sleep

Puberty is a complex physiological, cognitive and psycho-social cascade of changes. Sleep disturbances can arise during this essential time, which may adversely affect growth, health and development. Most of you who have adolescents at home are well aware of these complex changes; well so am I. My great sleeper, who used to fall asleep the minute his head would hit the pillow around 9, now walks the hallways till 11 or midnight at times, unable to fall asleep. I have decided to look deeper into this common phenomenon that affects so many teens to see what suggestions I can find in literature.

To start off, we need to dive into basic physiology of sleep.  Sleep is regulated by two body systems: sleep/wake teens-sleep-patternhomeostasis and the circadian rhythm. The sleep/wake homeostasis lets our body know when it needs to rest. The circadian rhythm, regulate the time period of sleepiness and wakefulness. Changes in the circadian rhythm occur during adolescence as part of physiological process. This natural shift is called sleep phase delay. Teen who used to go sleep around 8-9 pm at night before puberty, now won’t be able to fall asleep till 10 or 11 pm. Since most adolescents have early school start, this sleep phase delay can make it difficult for the teenagers to get recommended 9 hours of sleep. For adolescents the strongest circadian “dips” tend to occur between 3-7 am and 2-5 pm.

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Organic vs. conventional food

I like food!!

I like to eat and cook, and whenever I can, I prepare meals from a scratch. I cook for my whole family, trying to satisfy everyone’s cravings, especially the toughest critics – my kids. That is why, I pay special attention to ingredients.

For many years now, I have been slowly progressing towards organic food. I usually use mostly organic ingredients, unless I cannot find the once that answer my requirements, at which time I turn to conventional products. The other day, we had friends over for dinner and got into conversation about organic vs conventional food. To my great surprise, I realized that many people choose to omit eating certain products for a sole reason – not organic. I decided it was time for me to re-visit organic food vs conventional food and its effect on children.

First, let’s start off with defining what organically-grown foods mean. Organically-grown foods are grown without the use of synthetic fertilizers or pesticides. Organic food is not necessarily is 100% made of all organic ingredients. The United States Department of Agriculture (USDA), mandates for all ingredients to be organically certified for a product to be labeled “100 percent organic”. “Organic” labeled food usually consist of at least 95% certified organic ingredients. Products with at least 70% certified organic ingredients are labeled as “made with organic ingredients”.

So, what is being looked at when organic food gets compared to conventional? Food related illness, such as gastroenteritis. Food usually becomes contaminated by raw manure fertilization, crops irrigation with contaminated water, or fecal contamination during processing and handling. The risk of contamination with bacteria resistant to multiple antibiotics is higher in conventionally grown products, but overall risk of bacterial contamination is not different. To minimize the food-borne illnesses, always follow this simple rules:

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Common Cold

As the tree leaves succumb to fall and temperatures drop, the dreaded common cold season begins. Sneezing, rhinorrhea (runny nose), coughing, sore throat, general malaise (feeling ill), low grade fever are some of the symptoms of the common cold. It’s an acute viral, self-limited illness. It requires no antibiotics and the treatment of care is supportive. I thought it would be a good idea to remind about some of the recommendations that may help to get back on feet quickly and remain healthy.

Common cold (also known as viral infection), is usually caused by various respiratory viruses. It is an acute illness, whose symptoms usually peak on 2nd or 3rd day of illness and gradually improve over time. In general, in infants and young children, the symptoms may last over 10-14 days. In older children and adolescents, symptoms usually resolve within a week or less.

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Influenza and vaccines

My longtime friend has asked me to write a bit on influenza and vaccination guidelines.  As medical provider, I always strive to provide my patients with as much information as possible to allow them to make the best educated choices for their children based on the latest American Academy of Pediatrics (AAP) and Centers For Disease Control (CDC) guidelines.

In order for us to understand why the flu vaccine may prevent majority of flu illness in some years and be somewhat less effective in others, I will quickly go over the fascinating flu vaccine evolution.

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Hurricane Joaquin – Be Ready

With Hurricane Joaquin threatening to hit East US coast area, as soon as this weekend, now would be a good time to review “Disaster-ready essentials for parents with children”.  Apart from stocking up on the most essential things (food, water, batteries, flashlights, candles, etc), having your car fully filled up with gas, here are few things that you may want to consider:

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Splenomegaly and Infectious Mononucleosis

In light of recent tragedy, with heavy heart and great respect for grieving family and friends of the young athlete that recently passed away from spleen rupture, I would like to review the  most common medical condition that may cause splenomegaly (enlarged spleen), where premature resumption of sports can be life-threatening.


In order to understand why spleen gets enlarged, it would be beneficial to review many different functions of spleen. Imagine spleen as yin and yang.  Yang, the white part, represent “white pulp”of the spleen.   It is made of lymphatic tissue.  Spleen is one of many immunological centers in our body where antibodies get formed in response to various antigens (e.g.viruses, bacteria,yeast, etc).  Yin, the dark part, represents “red pulp” of the spleen.  As the name implies, it is a very vascular part of the spleen.  Its function is to destroy any cells that are abnormal.  Spleen also acts as a reservoir for platelets.  As a result of these many functional components within the spleen, the etiology of splenomegaly may relate to an increase in a normal splenic process (e.g., hemolysis) or may be due to infiltrative, infectious, or vascular disorders.

In this post, I am only going to be concentrating on a tip of the iceberg – Infectious Mononucleosis (also known as Glandular fever, Kissing disease, Mono or Mononucleosis).  Continue reading “Splenomegaly and Infectious Mononucleosis”