Book an Appointment
Emergency: 022-61305005
I want to find
My Health Records

Menstrual Disorders

Management Team

Menstrual Disorders

Overview

A menstrual disorder refers to any disruption in the normal menstrual cycle, involving abnormal conditions that affect a woman’s hormone balance and menstrual cycle. 

Menstrual disruptions can take different forms:

  • Heavy periods (menorrhagia): Bleeding that is excessively heavy or prolonged.
  • Painful periods (dysmenorrhea): Menstrual cramps that are more severe than usual.
  • Irregular periods (oligomenorrhea or polymenorrohea): Cycles that are too long (more than 35 days) or too short (less than 21 days).
  • Missed periods (amenorrhea): No period for three or more consecutive months, without being pregnant.
  • Premenstrual syndrome (PMS): A group of emotional and physical symptoms occurring before the start of menses.
  • Premenstrual dysphoric disorder (PMDD): A more severe form of PMS that leads to significant mood changes and disruption to daily life.

The causes of menstrual disorders vary depending on the type of issue, and sometimes multiple factors are involved:

  • Hormonal imbalance: Fluctuations in the levels of hormones such as oestrogen and progesterone can cause irregularities in the menstrual cycle. Hormonal imbalances are especially common during puberty, after childbirth, and close to menopause.
  • Pelvic inflammatory disease (PID): Irregular periods and pain can occur as a result of infections in the female reproductive organs.
  • Polycystic ovary syndrome (PCOS): This leads to irregular periods and is often associated with elevated levels of androgens (male hormones).
  • Thyroid disorders: Menstrual irregularities is often seen among those with an overactive or underactive thyroid (hyperthyroidism or hypothyroidism, respectively).
  • Uterine fibroids: Heavy or prolonged periods can occur due to non-cancerous growths called polyps in the uterus.
  • Endometriosis: Tissue or cells mimicking the uterine lining starts growing at abnormal places, leading to painful periods.
  • Medications: Birth control pills, blood thinners, and some other medications can affect your cycle.
  • Stress and lifestyle factors: Significant stress, rapid weight changes, or extreme exercise can disrupt the menstrual cycle.

The symptoms of menstrual disorders depend on the specific condition, but common signs to watch out for include:

  • Unusually heavy bleeding (hourly usage of more than one tampon or napkin for several times)
  • Prolonged periods (lasting over seven days).
  • Bleeding between periods or after menopause.
  • Missing periods for three or more months.
  • Severe menstrual cramps that are not alleviated with over-the-counter pain relievers.
  • Fatigue, dizziness, or shortness of breath due to heavy blood loss.
  • Mood swings, irritability, or depression around the time of your period (especially if it severely affects your daily life).

Taking a detailed medical history and asking questions about your cycle. Depending on your symptoms, we may use the following diagnostic tools:

  • Pelvic exam: This helps doctors identify any abnormalities in the reproductive organs.
  • Blood tests: These can help doctors ascertain the presence of hormonal imbalances, thyroid issues, or underlying health conditions.
  • Ultrasound: An imaging test to closely examine the uterus, ovaries, and pelvic organs, checking for fibroids, polyps, or cysts.
  • Endometrial biopsy: Sample of the uterine lining is obtained to rule out other conditions.
  • Hysteroscopic surgery: A thin, lighted instrument that allows doctors to look inside the uterus is used; this test helps doctors detect abnormalities like fibroids or polyps.

The treatment for menstrual disorders depends on the cause, but here are the most common options:

  • Medication: Pain relievers like ibuprofen can help reduce cramps and bleeding. Hormone-based treatments, such as birth control pills, can regulate or lighten periods.
  • Hormone replacement therapy (HRT): For hormone imbalance treatment, options such as progestin therapy or hormonal IUDs can help reduce the intensity of bleeding and regulate the menstrual cycle.
  • Surgery: If uterine fibroids or polyps are causing heavy bleeding, surgery to remove them may be recommended. For endometriosis, laparoscopic surgery can be used to remove tissue growths.
  • Lifestyle adjustments: Sometimes, simple changes like stress management, exercise, and maintaining a healthy weight can make a noticeable difference.
  • Treatment for underlying conditions: If thyroid disease, PCOS, or another condition is the cause of your menstrual disorder, addressing that condition is the first step in restoring balance to the menstrual cycle.

Periods may be a natural part of life, but that does not mean you have to suffer in silence. If

your cycle is impacting your life, it is advisable to get it checked.

While it is not always possible to prevent menstrual disorders, maintaining a healthy lifestyle can help keep your cycle regular and your symptoms manageable:

  • Maintaining a healthy weight
  • Regular exercise
  • Appropriate stress management
  • Consumption of a balanced, nutritious diet
Filter Alphabet

Guillain-Barre Syndrome

Management Team

Guillain-Barre Syndrome

Overview

Guillain Barre syndrome is a prevalent cause of acute neuromuscular paralysis.

Guillain Barre syndrome is an acquired neuropathy caused due to the formation of autoantibodies, which are generated in response to infections caused by Campylobacter jejuni, Cytomegalovirus (CMV), Epstein–Barr Virus, Haemophilus influenzae, and Mycoplasma pneumoniae. Common antibodies associated are ganglioside antibodies (GM1) in acute inflammatory demyelinating neuropathy (AIDP), GQ1b antibody (Miller Fisher variant), and GD1a antibody in acute motor axonal neuropathy (AMAN).

  • Bacterial or viral infection
  • Surgery
  • Age over 50 years
  • Vaccinations in rare cases

  • Gradually worsening ascending muscle weakness, sometimes accompanied by paraesthesia, with symptoms typically peaking within four weeks
  • Progressive loss of tendon reflexes
  • Back pain and radicular discomfort
  • Weakness in respiratory muscles
  • Cranial nerve dysfunction, affecting facial and bulbar muscles
  • Autonomic system involvement
  • Occasional bladder and bowel dysfunction
  • Regional variants:
    • Miller Fisher syndrome (ophthalmoplegia, areflexia, and ataxia)
    • Acute pandysautonomia
    • Acute oropharyngeal palsy (similar to diphtheria)
    • Pharyngo-cervico-brachial pattern
    • Flaccid paraparesis variant
    • Pure sensory variant

Neurologist

  • Blood tests to rule out conditions mimicking GBS like hypokalaemia, porphyria.
  • CSF examination for albuminocytological dissociation
  • Antibody measurements
  • NCV may show prolonged F waves, demyelination with/ without conduction blocks (AIDP) or axonal degeneration as in AMAN or AMSAN variants
  • MRI to determine enhancement of nerve roots

  • Intravenous immunoglobulin (IV Ig) is treatment of choice.
  • Plasma exchange (PE)
  • Disease-modifying therapy
  • General supportive management
  • Monitoring of swallowing dysfunction
  • Management of respiratory insufficiency
  • Autonomic dysfunction management- arrhythmia/ blood pressure fluctuations
  • Thromboembolic complication prevention
  • Neuropathic pain treatment with gabapentin, carbamazepine, or tramadol
  • Physiotherapy
Filter Alphabet

Foetal Growth Restriction/Intrauterine Growth Restriction

Management Team

Foetal Growth Restriction/Intrauterine Growth Restriction

Overview

Foetal growth restriction (intrauterine growth restriction; IUGR), refers to the failure of the foetus to grow at the expected rate during pregnancy. Essentially, this means that the baby is smaller than it should be for its gestational age, i.e., the number of weeks into the pregnancy. Babies with IUGR often weigh less than 90% of other babies at the same stage of pregnancy. Nevertheless, it is important to note that just because a baby is “smaller in size” (than usual), it does not necessarily mean that it has IUGR; in some cases, the parents may have certain underlying medical conditions that result in the foetus being smaller than usual. Often, IUGR not only affects the size of the baby but also the growth of organs and tissues. Thus, if not managed properly, IUGR could lead to several complications, such as breathing problems, increased susceptibility to infections and heart/blood vessel problems, and/or premature delivery or emergency C-section; in some serious cases, stillbirth or death could also occur.

There are two types of IUGR:

  • Symmetrical IUGR: The baby’s entire body is growing smaller than normal.
  • Asymmetrical IUGR: The baby’s head is growing at a normal rate, but the rest of the body is smaller.

Several factors can contribute to IUGR. Some are related to the baby’s health, others to the placenta, and some to the mother’s overall health. Here are a few common causes:

  • Placental issues: The placenta is responsible for delivering oxygen and nutrients to your baby. If the placenta is not functioning as it should, the baby’s growth can be affected.
  • Maternal health conditions: Hypertension, diabetes, or some infections may increase the risk of the development of IUGR.
  • Lifestyle factors: Smoking, drinking alcohol, or poor nutrition during pregnancy can contribute to growth restriction.
  • Multiple pregnancies: If you are carrying twins or more than 2 babies, the babies may have to compete for space and nutrients, increasing the risk of IUGR.
  • Chromosomal abnormalities: Sometimes, a baby’s growth is restricted because of genetic issues.

The tricky part about IUGR is that usually, there are no outward symptoms that a mother can feel. This makes regular prenatal check-ups essential. However, there are signs your doctor can detect, such as:

  • Smaller-than-expected baby bump: If your belly is measuring smaller than expected for your stage of pregnancy, it might indicate IUGR.
  • Low amniotic fluid levels: This can be another clue that your baby is not growing at the usual pace.

IUGR is typically diagnosed through careful monitoring during your prenatal check-ups; one or more of the following methods may be used:

  • Measuring the fundal height: Your doctor measures your belly from the top of the uterus to the pubic bone. If the measurement is smaller than expected for your stage of pregnancy, further investigations are needed.
  • Ultrasound: An ultrasound yields a more detailed view of the foetal growth; the foetal head, abdomen, and femur can be measured to check for signs of growth restriction.
  • Doppler ultrasound: This test is used to check the blood flow in the umbilical cord and other vessels to see if the baby is getting enough oxygen and nutrients.
  • Non-stress test: The baby’s heartbeat is monitored to ensure that it is not under stress.
  • Amniocentesis: In rare cases, this test may be performed to check for any genetic abnormalities that could be affecting the baby’s growth.

Here are the key approaches:

  • Frequent monitoring: If the IUGR is mild, the doctors may recommend close monitoring with more frequent ultrasounds and tests to keep a close watch on your baby’s growth.
  • Improving maternal health: If high blood pressure or diabetes is the cause, the doctors will focus on normalising blood pressure and diabetes treatment.
  • Nutritional support: A healthy, balanced diet is crucial. In some cases, extra nutritional support or supplements might be needed.
  • Bed rest: In some situations, bed rest is advised, which can help in improving the blood flow to baby.
  • Early delivery: If the baby’s health is at risk, sometimes, it is safer for the baby to be delivered early. This might involve inducing labour or performing a caesarean section delivery. The timing of delivery will depend on how far along the patient is and how the baby is coping inside the womb.

The availability of high-risk pregnancy care is extremely important for the timely detection and treatment of IUGR.

Regular prenatal visits are key to detecting IUGR early. However, you should seek medical advice if:

  • You notice a significant decrease in foetal movements (you should feel about 10 movements every 12 hours in the later stages of pregnancy).
  • You have sudden or severe symptoms like intense headaches, vision changes, or swelling, especially if you have conditions like hypertension (high blood pressure).

One or more of the following methods are recommended for the prevention of IUGR:

  • Healthy diet: Baby’s growth depends on a nutritious and balanced diet throughout pregnancy.
  • Quitting smoking and avoiding alcohol: These substances directly affect your baby’s development and should be avoided entirely during pregnancy.
  • Regular prenatal care: Keep all your scheduled appointments and follow your doctor’s recommendations to check your health and your baby’s development.
  • Manage chronic illness: During pregnancy, work closely with your doctor to manage the chronic illness such as hypertension, diabetes, or other disorders.
  • Stay active: Gentle, regular exercise can promote healthy blood flow, which benefits both you and your baby.
Filter Alphabet

Fibroids

Management Team

Fibroids

Overview

Uterine fibroids (leiomyomas or myomas) represent non-cancerous growths that develop in the uterine wall. They can vary in size and have been reported to be small (pea-sized) and sometimes, quite large (melon-sized). In many cases, fibroid formation does not cause any symptoms; however, depending on their size and where they are present, fibroids may cause discomfort or complications. Fibroids are quite common; in fact, research suggests that fibroid formation will occur in up to 70–80% of women by the age of 50 years. While fibroid development can be concerning, most fibroids do not increase the risk of cancer; they are often manageable with the right approach.

Based on their location in the uterus, fibroids may be categorised as follows:

  • Subserosal fibroids: The most common type of uterine fibroids; they grow on the outside lining of the uterus.
  • Intramural fibroids: They grow within the muscular uterine wall.
  • Submucosal fibroids: They grow within the space inside the uterus.
  • Pedunculated fibroids: They grow on a long stalk inside or outside the uterus.

Several factors have been reported to contribute towards fibroid formation in the uterus:

  • Hormonal factors: Fibroids are sensitive to hormones, particularly oestrogen and progesterone. These hormones stimulate the growth of the uterine lining during the menstrual cycle, and fibroids often shrink after menopause when hormone levels drop.
  • Genetic predisposition: If you have a family history of fibroids, you may be more likely to develop them yourself. Certain genetic mutations have also been linked to fibroid formation.
  • Cellular changes: Fibroids arise from smooth muscle cells in the uterus that proliferate rapidly. This growth may be influenced by various growth factors and hormones.
  • Environmental factors: Research is ongoing regarding lifestyle and environmental factors that may contribute to fibroid development, including diet, obesity, and exposure to certain chemicals.

  • Heavy menstrual bleeding
  • Pressure in the pelvis or pelvic pain
  • Frequent urination: when fibroids press against the bladder
  • Dyspareunia (painful sexual intercourse) 
  • Lower back pain
  • Constipation

Usually, the diagnosis of fibroids involves a physical examination to check for any abnormalities in your uterus and pelvic area. The following accessory methods may also be used:

  • Ultrasound: Sound waves are used to create images of the uterus; this will help ascertain the presence of fibroids and their size and location.
  • Magnetic resonance imaging (MRI): This also helps provide detailed images of the uterus and can help differentiate between fibroids and other conditions.
  • Hysterosalpingography (HSG): This is an X-ray-based procedure involving the injection of a contrast dye into the uterus to examine its shape and check for fibroids or blockages.
  • Hysteroscopic surgery: A thin, lighted tube is inserted into the uterus through the vagina; thus, the doctor can directly view the inside of the uterus.

The approach to treating fibroids largely depends on their size, location, symptoms, and whether you plan to become pregnant in the future. Here are some common treatment options:

  • Watchful waiting: If the fibroids are small and do not cause notable symptoms, the doctor may recommend that they be monitored over time.
  • Medications: Hormonal therapies, such as birth control pills, can help alleviate symptoms such as heavy bleeding. Gonadotropin-releasing hormone (GnRH) agonists may be used to temporarily shrink fibroids.
  • Minimally invasive procedures: Uterine artery embolisation (UAE) may be performed to block the blood supply to the fibroids; this will cause them to shrink.
  • Laparoscopic myomectomy: Fibroids may be removed using this minimally invasive surgery; this surgery is beneficial as it helps preserve the uterus.
  • Traditional fibroid surgery: Abdominal myomectomy may be recommended to remove fibroids through an incision in the abdomen; this is usually recommended for larger fibroids or those present in challenging locations.
  • Hysterectomy: In some cases, removal of the uterus may be necessary, especially if the fibroids cause significant problems or if a woman does not wish to get pregnant in the future. Laparoscopic hysterectomy is a minimally invasive surgery.

  • You experience heavy or prolonged menstrual bleeding that disrupts your daily life.
  • You experience severe pelvic pain or discomfort.
  • You experience changes in your menstrual cycle or bleeding patterns.
  • You exhibit symptoms of anaemia, such as fatigue or weakness, due to heavy bleeding.
  • You observe any concerning changes in bladder or bowel habits.
Filter Alphabet
F

Endometriosis

Management Team

Endometriosis

Overview

Endometriosis is a condition in which the endometrial tissue, i.e., the tissue that normally lines the inside of your uterus (the endometrium), starts growing outside the uterus. These misplaced bits of tissue behave just like they would inside the uterus: they thicken, break down, and bleed with your menstrual cycle. However, this blood cannot exit the body and thus, becomes trapped, leading to pain, inflammation, and scar tissue formation. Sometimes, endometriosis is associated with the formation of adhesive bands of fibrous tissues, due to which pelvic tissues and organs may stick to each other. While endometriosis affects the ovaries, fallopian tubes, and the tissues lining your pelvis, in more severe cases, it may even spread to other organs beyond the pelvic region. Endometriosis is associated with a great deal of discomfort and pain, especially during the menstrual cycle; in many cases, it has also been reported to cause fertility problems.

The exact cause of endometriosis is still somewhat of a mystery, but several theories exist:

  • Retrograde menstruation: This theory postulates the backward flow of endometrial cell-rich menstrual blood into the fallopian tubes and eventually, into the pelvic cavity. These cells then adhere to the pelvic organs, where they start to grow.
  • Embryonic cell transformation: Hormones such as oestrogen may cause embryonic cells (which can develop into any type of body tissue) to transform into endometrial-like cell implants during puberty.
  • Immune system disorders: Sometimes, the immune system may fail to recognise endometrial tissue growing outside the uterus, allowing it to continue developing.
  • Surgical scars: After surgeries like caesarean section delivery, endometrial cells might attach to surgical incisions; this can cause endometriosis.
  • Genetics: If a patient’s mother or sister has endometriosis, the patient has a higher risk of developing this condition.

  • Pelvic pain: This is the hallmark of endometriosis. Pain may start before your period and continue through it. It is often much more intense than typical menstrual cramps.
  • Dyspareunia (painful sexual intercourse): Many women with this condition report pain during or after sex.
  • Pain during bowel movements or urination: These symptoms are most common during the menstrual cycle.
  • Excessive bleeding: Some women experience heavy periods or bleeding between periods.
  • Infertility: Endometriosis can make it harder to conceive. In fact, this condition is often diagnosed in women undergoing fertility treatments.
  • Other symptoms: Patients may experience fatigue, nausea, bloating, constipation, or diarrhoea, particularly during your menstrual cycle.

  • Pelvic exam: During a pelvic exam, cysts or scar tissue near your reproductive organs may be felt
  • Ultrasound: A transvaginal or abdominal ultrasound can help identify cysts caused by endometriosis, called endometriomas.
  • Magnetic resonance imaging (MRI): An MRI can provide a detailed image of the internal organs and help plan surgeries or other procedures.
  • Laparoscopy: This is the gold standard for diagnosing endometriosis.

One or more of the following methods may be recommended for endometriosis treatment:

  • Pain medication: Over-the-counter pain relievers (such as ibuprofen) can help alleviate mild symptoms.
  • Hormonal therapy: Hormones play a key role in endometriosis. Options include:
    • Birth control pills: These can regulate your menstrual cycle and reduce pain.
    • GnRH agonists: These drugs temporarily stop your body from producing certain hormones, putting you into a temporary menopause.
    • Progestin therapy: This can reduce or stop menstrual flow and the growth of endometrial implants.
  • Surgery: If conservative treatments are not effective or if the patient is trying to conceive, surgery to remove as much endometrial tissue as possible may be recommended. Laparoscopic surgery is often used to remove or destroy growths, scar tissue, and adhesions.
  • Fertility treatment: If endometriosis is causing infertility, assisted reproductive techniques like in-vitro fertilisation (IVF) may be necessary.
  • Hysterectomy: In severe cases, removing the uterus—hysterectomy—may be considered, which includes laparoscopic hysterectomy. This is generally recommended only if you are not planning to have children in the future and is usually the last resort.

  • You have severe pelvic pain that does not go away even after the consumption of over-the-counter pain medications.
  • You are unable to conceive for over a year despite repeated attempts.
  • Your periods have become unusually heavy or irregular.
  • You experience pain during or after intercourse.
Filter Alphabet
E

Diabetes in Pregnancy/Gestational Diabetes Mellitus (GDM)

Management Team

Diabetes in Pregnancy/Gestational Diabetes Mellitus (GDM)

Overview

Diabetes associated with pregnancy or gestational diabetes, happens when your body has trouble managing blood sugar levels while you are expecting. While the condition usually develops in the second half of pregnancy, sometimes, pre-existing diabetes can complicate pregnancies. Nevertheless, regardless of whether the patient is dealing with this condition for the first time or managing pre-existing diabetes, controlling blood sugar levels is crucial to keep the patient and the baby safe and healthy. Gestational diabetes disappears soon after the delivery. However, gestational diabetes has been reported to increase the risk of developing type 2 diabetes; hence, consistent blood sugar monitoring of the patients is crucial.

The placenta, which supports the baby’s growth, produces hormones that can interfere with the action of insulin, a hormone that helps regulate the blood glucose levels. The blood sugar levels increase when the body cannot produce adequate insulin to maintain the blood glucose levels; this leads to gestational diabetes.

Certain factors that increase the likelihood of diabetes development during pregnancy include:

  • Obesity: Being overweight or obese before pregnancy increases the risk of developing gestational diabetes.
  • Age: Women over 35 have a higher chance of developing gestational diabetes.
  • Family history: If diabetes runs in your family, your chances are higher too.
  • Polycystic ovary syndrome (PCOS): PCOS has been reported to increase risk of developing gestational diabetes.
  • Previous history of gestational diabetes: If you had diabetes during a previous pregnancy, you are more likely to develop it again.

Gestational diabetes can sneak up on you because for many women, there are no noticeable symptoms. Hence, screening tests during pregnancy are very important. However, some women may experience: 

  • Unusual thirst
  • Frequent urination
  • Fatigue
  • Blurred vision

Approximately 24 to 28 weeks into pregnancy, a glucose screening test (OGTT) is performed. This involves drinking a sugary liquid; then, the blood sugar levels are measured after 1 and 2 hours.

Gestational diabetes is managed with a multidisciplinary approach involving an obstetrician, endocrinologist, dietician, and diabetes nurse. The major aspects that are focus upon are as follows:

  • Healthy diet: A well-balanced, nutritious diet, which includes fruits, vegetables, lean proteins, grains/cereals, and diary. Avoiding snacks, sweets, and foods that are processed helps too.
  • Monitoring blood sugar: Regular monitoring of blood sugar.
  • Exercise: Physical activities such as walking, jogging, swimming, or yoga are also beneficial for lowering blood sugar levels.
  • Medication: In some cases, lifestyle changes alone are not sufficient; medications or insulin injections are required to modulate the blood sugar levels.
  • Regular monitoring:  Closely monitoring the baby’s growth, usually with ultrasound imaging, can help ensure that everything is on track with regard to the pregnancy.

While you cannot always prevent gestational diabetes, one or more of the following steps may be taken to lower the risk of developing this condition:

  • Maintenance of healthy weight (obesity management or healthy weight gain) before pregnancy
  • Consumption of a balanced diet
  • Regular exercise
  • Regular check-ups
Filter Alphabet
D

Paediatric Diarrhoea

Management Team

Paediatric Diarrhoea

Overview

Paediatric diarrhoea, a common yet potentially dangerous condition, is characterised by frequent, loose, or watery stools, which can lead to dehydration, malnutrition, and even death. It poses a significant health impact on children worldwide. Our hospital has advanced diagnostic imaging and treatment protocols which play an essential role in managing and mitigating the consequences of paediatric diarrhoea.

Paediatric diarrhoea can be triggered by both infectious and non-infectious factors. Infectious agents include viruses, bacteria, and parasites.

  • Viral infections: Viral gastroenteritis, which is often caused by rotavirus and norovirus, is the most common cause of acute diarrhoea in children.
  • Bacterial infections: Pathogens, such as Escherichia coli, Salmonella, and Shigella, can cause severe diarrhoea and are often associated with severe symptoms.
  • Parasitic infections: Amoebiasis and other parasitic infections, though less common, can occur in regions with poor sanitation.
  • Non-infectious causes: The non-infectious causes of paediatric diarrhoea include food allergies, lactose intolerance, inflammatory bowel disease (IBD), and celiac disease.
  • Antibiotic use: Prolonged broad-spectrum antibiotic therapy may cause antibiotic-associated diarrhoea.

The symptoms of diarrhoea vary in severity depending on the cause and extent of dehydration.

  • Frequent loose stools: The primary symptom of diarrhoea is frequent loose stools, which is often accompanied by cramping.
  • Abdominal pain and cramping: Abdominal pain and cramping are common complaints associated with diarrhoea.
  • Fever and vomiting: Fever and vomiting may occur in cases of viral or bacterial infection.
  • Dehydration: Dehydration, a critical concern in paediatric diarrhoea, can manifest as dry mouth, sunken eyes, decreased urination, lethargy, and, in severe cases, shock.

Diagnosis of paediatric diarrhoea in a hospital setting involves a thorough evaluation.

  • Detailed medical history and physical examination: Obtaining a detailed medical history and physical examination, such as assessing stool frequency, consistency, duration, and other associated symptoms is crucial in determining the cause and severity of paediatric diarrhoea.
  • Stool analysis: This includes microscopy, culture, and sensitivity tests for detecting bacterial pathogens, tests for detecting ova and parasites, and stool PCR for identifying viral pathogens.
  • Blood tests: Complete blood count (CBC), electrolytes, renal function tests, and inflammation markers are common tests prescribed to assess the cause of diarrhoea and determine its subsequent treatment.
  • Imaging and endoscopy: Imaging and endoscopy are used in cases of chronic diarrhoea or when an underlying pathology (such as IBD) is suspected.

The management of paediatric diarrhoea focuses on rehydration, managing the underlying cause, and preventing complications.

  • Oral rehydration therapy (ORT): This is the first line of treatment for mild to moderate dehydration. ORT solutions, which contain an appropriate balance of salts and glucose, are highly effective and can be administered at home or in healthcare settings.
  • Intravenous (IV) rehydration: IV rehydration is necessary in cases of severe dehydration or when ORT is not feasible. Tertiary care hospitals are well-equipped to provide IV fluids and monitor critically ill children.

Specific treatments for diarrhoea include:

  • Viral diarrhoea: Viral diarrhoea can generally be managed with supportive care, including hydration and dietary adjustments.
  • Bacterial diarrhoea: Antibiotics are used for certain bacterial infections, but they are used judiciously to avoid resistance and complications.
  • Parasitic infections: Parasitic infections are generally treated with antiparasitic medications.
  • Non-infectious causes: Non-infectious causes are managed according to the underlying condition, such as dietary modifications for lactose intolerance or immunosuppressive therapy for IBD.
  • Nutritional support: Nutritional support is crucial in paediatric diarrhoea management. Continued feeding or breastfeeding is encouraged to maintain nutritional status and promote recovery.

Diarrhoea prevention measures in children focus on reducing exposure to pathogens and improving sanitation.

  • Vaccination: Rotavirus vaccination plays a key role in preventing viral gastroenteritis.
  • Hygiene: Proper handwashing, safe food preparation, and clean drinking water can reduce diarrhoeal illness.
  • Nutritional support: Ensuring adequate nutrition during episodes of diarrhoea helps prevent malnutrition and promotes faster recovery.
Filter Alphabet
P

Fever in Children

Management Team

Fever in Children

Overview

Fever in children is a frequent cause for medical consultation, prompting concern among parents. It is defined as an increase in the body temperature above the normal temperature of 98.6°F (37°C). While fever itself is not a disease, it is a sign of an underlying condition, typically an infection. In a tertiary care hospital setting, proper evaluation and management of paediatric fever are critical due to the potential severity of underlying causes.

Fever in children can be triggered by various conditions, most commonly infections.

  • Viral infections: Influenza, respiratory syncytial virus (RSV), and enteroviruses are the leading viral causes of fever in children.
  • Bacterial infections: Conditions, such as urinary tract infections (UTIs), streptococcal pharyngitis, bacterial meningitis, and sepsis can cause high fever.
  • Non-infectious disease: Autoimmune diseases, malignancies, and inflammatory conditions can also present with fever but are less common in the paediatric population.
  • Immature immune system: The epidemiology of paediatric fever varies with age, geographic location, and season. Young children, particularly those aged under 5 years, are susceptible to febrile illnesses due to their underdeveloped immune systems.
  • Exposure to pathogens: Communal settings like daycare centres and schools increase the risk of infection.

Symptoms accompanying fever in children can vary depending on the underlying cause.

  • General symptoms: Irritability, lethargy, poor feeding, vomiting, cough, diarrhoea, and rash.
  • Localised symptoms: In older children, localised symptoms, such as sore throat, ear pain, or abdominal pain can help identify the source of infection.
  • Severe symptoms: Signs of serious illness, such as high fever, difficulty breathing, or persistent vomiting may indicate more severe underlying conditions.

The diagnostic of fever in children involves systematically evaluating the cause and severity.

  • Medical history: Recording details, such as fever duration, pattern of fever, associated symptoms, recent exposures, and vaccination status is crucial.
  • Physical examination: This helps detect any localised signs of infection or other abnormalities.
  • Laboratory tests: Blood tests, urine analysis and cultures, and inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can guide diagnosis.
  • Imaging: Chest X-rays, abdominal ultrasounds, or other radiological studies are useful for identifying infection or inflammation.
  • Specialised tests: These include lumbar puncture for cerebrospinal fluid analysis in suspected meningitis cases or viral panels to detect specific viral pathogens.

Managing fever in children focuses on treating the underlying cause, alleviating discomfort, and preventing complications.

  • Severe illness: Supportive care for severe illnesses includes adequate hydration, administering antipyretics, such as paracetamol or ibuprofen for fever and discomfort, and monitoring for severe illness.
  • Viral infections: Viral infections usually require supportive care as most viral infections are self-limiting.
  • Bacterial infections: Antibiotics are prescribed based on the suspected pathogen, especially for serious conditions like sepsis or meningitis.
  • Non-infectious causes: Management may involve specific therapies, such as immunosuppressive agents for autoimmune diseases or chemotherapy for malignancies.
  • Hospital monitoring: Children with fever and signs of severe illness or underlying chronic conditions need to be closely monitored in a hospital setting. Advanced supportive care, including intravenous fluids, oxygen therapy, and intensive care, may be necessary for critically ill patients.

Preventing fever in children largely involves preventing the infections that cause it.

  • Vaccination: It is the most effective measure for many common pathogens, such as influenza, measles, mumps, rubella, varicella, and pneumococcus, and decreases the incidence of fever-causing infections.
  • Hygiene practices: Good hygiene practices, including regular hand washing, respiratory etiquette, and avoiding close contact with sick individuals, can also reduce the spread of infectious diseases.
  • Public health education: Education must be provided for parents and caregivers on recognising warning signs of serious illness, appropriate use of antipyretics, and the importance of vaccinations.
  • Child health initiatives: Promoting breastfeeding, proper nutrition, and overall health reduces the incidence and severity of febrile illnesses.
Filter Alphabet
F

Respiratory Tract Infections in Children

Management Team

Respiratory Tract Infections in Children

Overview

Respiratory tract infections (RTIs) in children are the leading causes of paediatric consultations, hospitalisations, and absence from school. These infections vary in severity, from mild upper respiratory tract infections (URTIs), like the common cold, to severe lower respiratory tract infections (LRTIs), such as pneumonia and bronchiolitis, which can lead to morbidity and mortality, especially in younger children and those with underlying health conditions.

RTIs in children are caused by various pathogens with certain factors increasing their susceptibility:

  • Viral infection: The most common causes of RTIs in children include respiratory syncytial virus (RSV), influenza viruses, rhinoviruses, and adenoviruses, which are often associated with widespread community outbreaks.
  • Bacterial infection: Bacteria, such as Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae, are frequently associated with severe LRTIs like pneumonia.
  • Underdeveloped immune system: As children have underdeveloped immune systems, they are susceptible to infections.
  • Communal exposure: Increased exposure to settings like schools and daycare centres increases the risk of infection spread.
  • Seasonal variation: Viral infections peak in colder months, contributing to high incidences of RTIs during winter.
  • Underlying conditions: Chronic health issues like asthma or congenital heart disease can worsen the severity of RTIs.

The symptoms of RTIs in children vary based on the site and severity of the infection.

  • Upper respiratory tract infections (URTIs): Symptoms include runny nose, cough, fever, sore throat, and nasal congestion, which are commonly associated with cold and pharyngitis.
  • Lower respiratory tract infections (LRTIs): They are associated with severe symptoms, including persistent high fever, persistent cough, wheezing, difficulty breathing, rapid breathing, and, in severe cases, cyanosis (bluish discoloration of the skin due to lack of oxygen) and hypoxia (insufficient oxygen in tissues).
  • Systemic symptoms: In severe cases of LRTIs like pneumonia, children, especially infants, may exhibit lethargy, irritability, and poor feeding.

Accurate diagnosis of RTIs in children is crucial for appropriate management, often involving a combination of clinical and advanced diagnostic tools.

  • Clinical evaluation: Physical examination, including auscultation of the lungs, helps detect abnormal breath sounds, such as crackles and wheezing that are indicative of LRTIs.
  • Laboratory tests: Blood tests including complete blood counts and blood cultures help differentiate between viral and bacterial causes, while specific viral panels can be used to confirm viral infections.
  • Radiological imaging: Chest X-rays are commonly used to assess the extent of infection in LRTIs like pneumonia based on lung consolidation or other changes.
  • Pulse oximetry: This simple, non-invasive test measures oxygen saturation and is crucial for assessing respiratory function in children with suspected severe LRTIs.

Management of RTIs in children is dependent on the type and severity of infection with supportive care being the cornerstone of treatment in most cases.

  • Supportive care: This includes hydration, fever management with antipyretics and analgesics, maintaining oxygenation, and providing paediatric respiratory support in cases of respiratory distress. Humidified air and nasal saline drops can help relieve nasal congestion.
  • Antibiotic therapy: Antibiotics that are prescribed for bacterial infections are not useful for viral infections, highlighting the importance of accurate diagnosis.
  • Antiviral medications: Antiviral drugs, such as oseltamivir are used for severe cases of influenza, but most viral infections are managed with supportive care.
  • Oxygen therapy and ventilation: In severe cases where children develop respiratory distress or hypoxia, hospitalisation is required for advanced paediatric respiratory support. Our hospital has a paediatric intensive care unit (PICU) and a neonatal intensive care unit (NICU) where both paediatric and neonatal patients with respiratory distress can receive advanced respiratory support, including mechanical ventilation if required.

Preventing RTIs is a key strategy to reduce their adverse impact on health. Various public health measures to prevent RTIs include:

  • Immunisation: Vaccines against influenza, pneumococcus, and Haemophilus influenzae type b (Hib) have significantly decreased the prevalence and severity of RTIs.
  • Hand hygiene and respiratory etiquette: Regular handwashing with soap, using hand sanitisers, and covering the mouth and nose while coughing and sneezing are simple but effective preventive measures.
  • Limiting exposure: Reducing children’s exposure to infected individuals, particularly in communal settings, and avoiding crowded places during peak seasons of infection can help prevent RTIs.
  • Breastfeeding: For infants, breastfeeding provides essential antibodies that help strengthen their immune system and protect against respiratory infections.
Filter Alphabet
R

Frontotemporal Dementia (FTD)

Management Team

Frontotemporal Dementia (FTD)

Overview

FTD affects individuals between 45–65 years. Fifty percent of cases show autosomal dominant inheritance pattern. Those individuals with parkinsonian features present with tau mutations on chromosome 17. FTD shows MND link association to chromosome 9.

Caused by anterior temporal and frontal lobe atrophy.

  • Family history in case of familial FTD
  • Head trauma
  • Thyroid disease
  • Other risk factors including cardiovascular comorbidities, diabetes, and autoimmune condition

Symptoms differ based on the types of disease:

  • Frontotemporal dementia
    • Altered personality, personal behaviour and social skills. (apathetic/disinhibited/overactive)
    • Progressive non-fluent aphasia
    • Perseveration
    • Loss of insight
    • Pure language deficit
      • Effortful and non-fluent speech
      • Impairment of well-rehearsed series, e.g. days of the week
      • Anomia
      • Comprehension intact
      • Impaired repetition
  • Semantic dementia
    • Loss of understanding of words
      • Cannot recognize faces/objects
      • Effortless and fluent speech, but without content
    • Semantic paraphasia, e.g. cat for dog
      • Impaired comprehension
      • Anomia
  • Frontotemporal dementia with MND
    • Amyotrophic lateral form of MND presented after dementia onset

Neurologist

  • Normal EEG
  • Anterior temporal and frontal lobe atrophy seen on MRI
  • FDG PET scan- shows hypometabolism of frontal and temporal areas

  • No specific treatment
  • Supportive care for behaviour abnormalities
  • Cognitive therapy
  • Social support
Filter Alphabet
F
Subscribe to Bottom to top