Monthly Clinical Meeting

20-08-2009
Thursday
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))

139
 Quiz - 5
Dr. Paresh Thakkar
pareshthakkar@yahoo.com
Answers to Quiz No. 5 are Regarding the cumulative scores, Dr
Sanjeev Goel is leading with the score of 44, Dr
41. A
Bhavesh Shah and Dr Nisarg are having second
42. B position at 42 & Dr Parul Valia having nearly the
43. A same score of 41. Dr Hitesh Desai is at 39 and Dr
Samir Shah having score of 38. I think it will be
44. D interesting to witness the dynamics of the scores.
45. B
46. B Q. 51 A 10 year old boy with insulin dependent
47. D diabetes, on a twice daily routine of long and short
acting insulin, reports regular hypoglycemia while
48. D
playing football in the afternoon. To prevent this
49. B problem, you should advise him to
50. D a. give less short acting insulin before breakfast
b. test his urine for sugar before playing football
c. give up playing football
Congratulations to the top scorers. The names of
the top scorers are as follows : d. eat extra carbohydrate such as a small
chocolate bar before football and to take
Score 09 : glucose tablets when he begins to feel
lightheaded.
- Dr Sanjeev Goel,
- Dr Nisarg Shah
Q.52 A 3 years old boy is brought to hospital after
- Dr Samir Shah, choking while eating peanuts. He was wheezy for
Score 08 : a few minutes but is now asymptomatic.
Regarding this which of following is a correct
- Dr Parul Valia, - Dr Bhavesh Shah,
statement?
- Dr Ashutosh Patel - Dr Hitesh Desai a. a chest X-ray is not indicated because a
Score 07 : peanut is not radio-opaque.
b. the risk of lung damage is less because the
- Dr Sanjay Majmudar,
inhaled material is organic.
With kind permission from AOP Vadodara, c. if he remains asymptomatic for 24 hours and
Post Graduate Students of the Pediatric physical examination is normal, he may be
Department Medical College Baroda were happy safely discharged home without further
to participate this time for the quiz. Practicing investigation.
pediatricians with busy practice have scored much d. bronchoscopy should be performed as soon
better. I think students should work hard to as possible.
improve their performance.
Q.53. All of the following conditions can be
Score 07 :
reliably diagnosed by mucosal biopsy
- Dr Amit Jetani - Dr Neha Jain except
- Dr Saurabh Modasiya - Dr Manan Parikh a. Sucrase deficiency
Score 06 : b. Cystic fibrosis
c. Helicobacter Pylori infection
- Dr Mandar Kale - Dr Sushma T. S.
d. Hirschprung’s disease.
- Dr Komal Parekh, - Dr Tarun Parmar

140
Q.54 All of the following may be the presenting which he was required to be admitted twice.
feature in case of Coaractation of the aorta except Presently on examination he is having tachypnea
a. clinical features suggestive of septic shock in with significant respiratory distress and cyanosis.
an infant Respiratory system examination is showing
b. pain in the legs on exercise in a school age bilateral extensive rhonchi. Which of the following
child blood gas analysis and electrolyte values are most
c. rib notching on a chest X-ray. closely matching with the given clinical situation?
d. postural hypotension in an adolescent. pH pCO2 pO2 Na K Cl HCO3
a 7.3 22 98 140 4.0 105 16
Q.55 A 13 year old child is having low grade fever b 7.55 25 99 140 4.0 108 25
and arthralgia. There is past history of hepatitis A
c 7.34 54 52 137 4.0 96 35
infection 1 year before. 10 days before he had
pharyngitis which was treated with penicillins. On d 7.24 24 99 136 4.0 96 12
examination he is having BP of 154 / 92 and mild
Q.58 A 16 year old boy has been reported to
pitting pedal edema. Rest systemic examination is
emergency room after suicidal ingestion of Aspirin
normal. Regarding laboratory investigations,
tablets. On examination the child is drowsy and
Hemogram is normal, urine showing large amount
tachypnic. Which of the following blood gas
of protein and presence of plenty of RBCs and
analysis and electrolyte values are most closely
RBC cast in urine microscopy. S Creatinine is 1.7,
matching with the given clinical situation?
serum electrolytes and blood urea is normal.
Which of the following is likely cause of his renal pH pCO2 pO2 Na K Cl HCO3
dysfunction? a 7.3 22 98 140 4.0 105 16
a. Allergic reaction to Penicillins b 7.55 25 99 140 4.0 108 25
b. High levels of compliment c 7.34 54 52 137 4.0 96 35
c. Immune complex mediated damage d 7.24 24 99 136 4.0 96 12
d. Previous infection with Hepatitis A.
Q.59 A six month old boy has been brought to
emergency room by mother. He has developed
Q.56 A 4 year old child is brought to the intense burning, itching and redness of the skin
emergency room by the parents. Parents found after sun exposure for five minutes. Urinary
him in the floor of bathroom barely breathing. The porphyrins are of normal levels. Which of the
contents of the medicine cabinet as well as the following is most likely diagnosis for this child?
cleaning products kept under the sink appear to a. Congenital Erythropoietic Porphyria
have been disturbed. His heart rate is 150/min,
b. Erythropoietic Protoporphyria
Respiratory rate is 8/min, BP is 60/35. The child is
intubated. Multiple attempts to establish venous c. Heriditory Coproporphyria
access have failed. Regarding fluid management d. Porphyria Cutanea Tarda
which of the following would be the most
appropriate next step Q.60 Colitis is associated with all of the following
except
a. Administration of fluid via Naso-gastric
tube. a. Cow milk protein allergy
b. Coeliac disease
b. obtaining Central venous access
c. Campylobacter infection
c. taking intra-osseous line
d. Hirschsprung’s disease.
d. performing saphenous cut down
Q.57. A 12 year old child with Chronic Persistent
Asthma presents with cough and breathlessness. Please email your answers
He is on inhaler therapy and some other oral toiapbarodaquiz@gmail.com or send sms to
drugs for the treatment of asthma. He has suffered Dr. Paresh Thakkar on 9426032150
4 episodes of respiratory tract infection out of Last Date : 31st August 2009

141
 The Matters of Money
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
142
Dr. Niranjan Shendurnikar
drniranjan@rediffmail.com
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!
 The Curious Case of Benjamin Button
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,
143
Dr. Niranjan Shendurnikar
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.
 Movie Review
- Love aajkal
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
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
144
Dr Bankim Parikh
bankimparikh@hotmail.com
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.
Vir Das...... Shonty
Raj Zutshi...... Harleen's father
Singers :
Neeraj Shridhar,
Master Saleem,
Suzi Q,
Sunidhi Chauhan,
Mohit Chauhan,
Rahat Fateh Ali Khan
KK
Lyricist : Irshad Kamil
Music Director : Pritam Chakraborty
 Birthdays and Anniversaries

Birthdays
02 Sept. Kairavi Pancholi 15 Sept. Beena Divyakant Patel
02 Sept. Jahnavi Sanjay Shah 16 Sept. Ashutosh Patel
03 Sept. Satish Daksha Shah 16 Sept. Parita Satish Pandya
04 Sept. Himanshu Parul Chauhan 17 Sept. Arun Phatak
04 Sept. Rupal Bhavesh Shah 18 Sept. Nitin Agarwal
06 Sept. Nita Mehul Shah 20 Sept. Sanjay Shah
07 Sept. Kamla T.B Patel 22 Sept. Nirupa Munshi
07 Sept. Rajesh Urmi Parikh 22 Sept. Heena Ritesh Shah
08 Sept. Ramila Dhanteja 22 Sept. Swetal Sunil Fajalia
09 Sept. Atharva Ravindra Pradhan 23 Sept. Shalin Bankim Parikh
10 Sept. Sahil Sanjay Majmudar 25 Sept. Dhairya Shreyas Shah (Jr.)
12 Sept. Disha Ashvin Shah 26 Sept. Arpit Nina Joshi
13 Sept. Harshil Haresh Patel 27 Sept. Saakshi Sanjeev Goel
13 Sept. Neha Mukesh Chandiramani

With Best Complements from :

Vrundavan Pharma
Deepak Sheth (Kaka) Mobile : 98254 59318
94265 62272
Available :
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.

145
 AMRIT KRISHNA
HEART CARE CLINIC
102, A-1, Sheetal Apartment, Opp. Panchratna,
Subhanpura Road, Ellorapark, VADODARA-23

Visit By Appointment Only

Contact No. 09825029744

Dr. Mahesh Bhatt

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

Dedicated Pediatric Cardiologist

146
Toprani Advanced Lab Systems
New Introduction

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

Please visit our Website – topranilabs.com for details

E mail - topranilabs@hotmail.com

HAEMOCARE
CENTRE
Centre for Diagnosis & Treatment Counseling

Blood Cancer Bleeding Disorders

v Leukemia ITP (Immune Thrombocytopenic Purpura)
v
v Lymphoma Hemophilia A & B
v
v Myeloma v
Von Willebrand Disease
v
DIC
Anemia v
TTP
v
Congenital v
Other Congenital & Acquired Bleeding Disorder
v
Acquired

Thrombotic Disorders
DVT (Deep Vein Thrombosis)
v
v
Pulmonary Embolism
v
Cerebral Vein Thrombosis
v
Congenital & Acquired Thrombophilia

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

147
 Pediatric Surgeon

Dr. Siddhartha Nayak

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

On Panel: Hospital :
[1] S.S.G.H. and Sanstha Vasahat, Pratap Road,
Govt. Medical College Raopura,Vadodara -390 001
[2] K. G. P. Children Hospital Mobile: 98250 62271
[3] O.N.G.C. Tele No: 0265-245 99 77

Hypospadias At Neel Surgical Hospital for children…………

• More than 200 cases of hypospadias operated in last 7 years
Did you know? • Modern techniques for surgery and treatment like
• It is one of the commonest congenital - Caudal anesthesia – more safe, excellent post op pain
anomalies only second to spina bifida relief.
and cleft lip and palate.
- Usage of loops for proper placements of microstitches.
• It is also the commonest anomaly
- Silastic catheters for urethra to minimize irritation.
which is missed by clinicians during
routine check ups. - Drugs to decrease postoperative bladder spasms.
• Not correcting it in time (before school are employed.
going age which is now 2 years) can • All thru out the stay child is kept busy with children friendly
lead to severe psychological effects on staff, cartoon shows, Children’s Books from ‘My library’ and
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

Neel Surgical Hospital for children

Karam Dham Complex, Near Atithigruh , Akota, Baroda.
For appointments : please call 0265-2312680

148
 KRISHNA
DEVELOPMENTAL CENTRE
'TOWARDS A BETTER FUTURE'
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. : 0265-6581121

Time – 9: 00 A.M. – 7: 00 P.M – Prior appt. necessary

Dr. Darshana Naik

MD
Consultant Pediatric Neurologist
Fellow Pediatric Neurology, Hinduja Hospital, Mumbai.
Fellow Pediatric Neurophysiology, London,UK

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

Facilities Available :
EEG, VideoEEG, EMG, NCV, BERA, VEP, SSEP, ERG
IQ test, Aptitude test, ADHD, Autism management

Asian Child Neuro Clinics and Cerebral Palsy Centre

2nd Floor, Park Avenue Building, Opp. Parimal Garden, Besides Piramyd Mall,
Ellisbridge, Ahmedabad. Phone : 079 - 26400640 • 9924181291

149
 Best compliments from

Padmasana Dental Clinic

Dr. Bhavna Haresh Dave
M.D.S. (Pedodontia)

Specialist in: Children Dentistry

202, Nimbalkar Chambers, S-9, National Plaza,

Kharivav Road, R.C. Dutt Road,
Dandia Bazaar, Alkapuri,
Vadodara. Vadodara.
Ph. – 2410390 Ph. - 2359792

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

Specialist in :
Correcting Protruded & Irregular Teeth &
Abnormally Growing Jaws.

Consulting & Visiting Orthodontist

Exclusive
Visiting Hours : 10 am to 1 pm
Orthodontics
5 pm to 8 pm

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

Tel : (C) 6544699, 2225999 (M) 98250 40106 (R) 2433888
email : anju_gohil@rediffmail.com • www.dranjugohilparikh.webraj.com

150
 With Best Compliments

Dr. Bhavesh M. Thakkar

Pediatric Interventional Cardiologist
Mobile : 9898022444

Add. :

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

Ahmedabad

2. Krishna Heart Institute, Ahmedabad

151
 DOSHI SURGICALS
Established: 1995 Mobile No: 9825043592
“Dealers In Surgical Disposable Items, Rehabilitation Aids, Consumer Goods,
Wide Range Of Innovative Medical Items. “
Distributors/Stokists : (Surgicals) Orthopedic/rehabilitation Aids
• B-d India Ltd. • Lp Supports,usa( Exclusive Range Of Neoprene &
• Medicare Hygiene Pvt.ltd.(medica Brand Dressing Material) Elastic Supports)
• Sangam Healthcare Products Ltd. (safti Brand Of Products) • Ortho-royal Inc.,bombay (wide Range Of Rehab/
• Kohinoor Products( Gauze/bandages) splints/footcare)
• Deepak Surgical (gallant Razor/skin Mate Skin Stappler/parakin • Foot & Ankle Co.,bombay( Foot Care Products/footwear)
Latex Gloves/cardio Tec Ecg Electrodes/daxi Flo I.v.regulator. • Samson Scientific & Surgicals.indore
• Kam Som Industries (abs.cotton) • Falcon Heating Pads
• Melody Plastic Products Pvt.ltd. (pov.iodine Etc.)
• Safeflo Urin Bag.
• Jms ( I.v/tape/scalp Vein Etc)
• Primwear(india)

Other Dealings :
* Ethicon (j&j) Sutures / * Nulife Gloves / * Kaltex Gloves / *alpha / I.v.fluids / leucoplast / b.brown / romsons/etc
Useful Products:
Quality Walking Aids/ Toilet Chairs/ Commodes / Wheel Chair/ Urin Pots/ Bed Pan/ Water Bed/ Air Bed/steam Inhalers/
weighing Scale/ Etc.
Proprietor: Bhadresh Doshi

Dr. Thakorbhai V. Patel Eye Institute

Sheth M.L. vadiwala Eye Hospital
Haribhakti Complex, Vinobha Bhave Marg, Salatwada, Vadodara - 01.
tvpeyeinstitute@yahoo.com, www.tvpei.org 0265 - 2410932
Offers

Pediatric Eye care

One of its kind in the city
Fully functional
Services Available : Surgical services available :
Age appropriate vision testing Pediatric Cataract : with posterior capsulorrhexis
Orthoptic workup Sutureless squint surgeries
Amblyopia management oblique muscle surgeries
Pediatric Neuroophthalmology set up Transpositions/Jensen's/Knapp's/Harada Ito surgeries
Orthoptic exercises Management of double vision/diplopia.
Head by
Dr. Jitendra Jethani
Consultant Pediatric Ophthalmologist For Appointment Call
MS, DO, DNB, FNB 0265 - 2410932, 2426311

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