Tuesday, March 29, 2016

How to try to differentiate Mumps from cervical lymph node enlargement?

I just saw a 5 year old boy with swelling in the angle of the jaw with mild pain 
I became a bit confused since I was not sure if the kid had Mumps or cervical Lymphadenopathy.
Here is what I found on reading about it... I guess this is basic information, but I was challenged by this case.

The Virus

Mumps is a viral illness caused by a paramyxovirus, a member of the Rubulavirus family. The average incubation period for mumps is 16 to 18 days, with a range of 12 to 25 days.

Clinical Features

Mumps usually involves pain, tenderness, and swelling in one or both parotid salivary glands (cheek and jaw area). Swelling is first visible in front of the lower part of the ear. It then extends downward and forward as fluid builds up in the skin and soft tissue of the face and neck. Swelling usually peaks in 1 to 3 days and then subsides during the next week. The swollen tissue pushes the angle of the ear up and out. As swelling worsens, the angle of the jawbone below the ear is no longer visible. Often, the jawbone cannot be felt because of swelling of the parotid. One parotid may swell before the other, and in 25% of patients, only one side swells. Other salivary glands (submandibular and sublingual) under the floor of the mouth also may swell but do so less frequently (10%). 
Photo of boy’s side face with glands labeledNonspecific prodromal symptoms may precede parotitis by several days, including low-grade fever which may last three to four days, myalgia, anorexia, malaise, and headache. Fever may persist for 3 to 4 days. Parotitis, lasts at least 2 days, but may persist longer than 10 days. However, mumps infection may present only with nonspecific or primarily respiratory symptoms, or may be asymptomatic. 
Mumps infection is most often confused with swelling of the lymph nodes of the neck. Lymph node swelling can be differentiated by the well-defined borders of the lymph nodes, their location behind the angle of the jawbone, and lack of the ear protrusion or obscuring of the angle of the jaw, which are characteristics of mumps.

People with mumps are usually considered most infectious for several days before and after onset of parotitis. Source
Mumps. The swelling of mumps parotitis crosses the angle of the jaw. On the other hand, cervical lymph nodes are usually below the mandible (Leung & Robson, 1991). Source

In my case, after reading up, I felt that the swelling was behind the angle of the jaw and I was able to feel the angle of the jaw, PLUS because the child was vaccinated, Mumps was less likely.
On the other hand, there is a hint of swelling appearing on the other side as well, and there is no other obvious focus, meaning that Mumps cannot be ruled out too.
So I have begun anti inflammatory, and kept Antibiotics on an as needed basis if the symptoms worsen.

Wednesday, March 16, 2016

The Dwindling Humaneness Of Medicine - Dr Sunil Chandy, Director CMC Vellore

Imagine you are a patient and you have a long story to tell your personal physician. You make an appointment with him. He lets you into his chamber, asks you to sit on a side stool and tell him your history. As you narrate, he is rapidly typing on the keyboard hardly looking at you. He intermittently asks you to stop the narration for him to catch up with typing. He still does not look at you. At the end of the consultation, he hands you a set of slips, investigations, prescription and a bill. Your data has been very accurately entered into the hospital information system, archived forever and he can retrieve it at will. As you move through, the lab is ready to take your blood and the pharmacy has already packed your drugs. This conveyor belt experience in Medicine is today the standard of care - efficient, rapid and standardized. But ask yourself this question - how satisfied and complete would you feel if your physician did not establish eye-contact, examined you and touched you with his hands. This is how most patients feel nowadays, with gadgets, monitors and scans replacing the human being in the doctor-patient relationship.  Medicine has undergone three radical changes which challenge the humane-ness of medicine. 
Reductionism: The spare-part approach induced by the specialist culture has broken our whole body into several parts. It is as if  the body is a warehouse of several organs, stacked and shelved in compartments to be taken out by specialists to treat and fix it back. Like the digital boards in electronic devices. The headache-to-a-neurologist --chest pain-to-a-cardiologist practice has been to the detriment of the human body as a whole. The interconnectedness of organ systems that talk to one another in disease and in health has been forgotten. As a result, the poor patient runs from pillar to post spending all his money without his problem being addressed. Quite often, it may just be an infected pimple in the sacral region that escaped the palpation of the physician.  
Standardization: The clamour for SOPs, guidelines and protocols has de-personalized medicine. To everything there is an algorithm, we just have to dig it out on 'Up-to-Date' and apply it. Apps freely available on smartphones is making the resident 'unsmart'.  These quick-aids have obviated the need to think and apply scientific logic in clinical situations.  No two human beings are alike, not even twins, then how can we even think of standardizing clinical practice. The heterogeneity of clinical presentations is the challenge of clinical medicine. The mystery of a certain presentation and the nuances of treatment add up to the thrill of being a physician.  Sherlock Holmes would testify to this. The algorithm-driven practice  of today has completely wrecked the joy of being a clinician. And this explains the disinterest among young physicians today.  

Read more at: https://www.docplexus.in/#/app/posts/1a814417-f8f0-4b6b-8781-2f5aab978bf0?utm_term=Email-Digest-2-morn&utm_campaign=Email-Digest&utm_medium=Email&utm_source=Docplexus.in&utm_content=CTA
Copyright 2016 © Docplexus

Thursday, March 10, 2016

Can A Smiling Doctor Cure A Visitor?

While researching on various trends in the healthcare practices, I came across an interesting finding by one of the renowned medical institutes. Cleveland Clinic, USA, through a detailed study of the HCAHPS (patient experience survey) data, found that most of the patients have a better experience when their doctors and caregivers smile more. The findings also said that when the doctors and nurses do not smile, patients interpret it as a means of hiding problems from them which leads to anxiety and impacts the experience. This potentially can create a trust deficit and hence sometimes might result in non-compliance with the prescribed treatment and possible medicolegal hassles for doctors. 
Do you think it is a valid observation? Do you think that a smile can create more trust between doctors and patients? Should adjunct staff personnel be trained regarding better patient care approaches? What are your experiences?

Read more at: https://www.docplexus.in/#/app/posts/b4747cdf-e5ed-4d9a-be5d-dabc1424c386?utm_term=Email-Digest-0-morn&utm_campaign=Email-Digest&utm_medium=Email&utm_source=Docplexus.in&utm_content=CTA
Copyright 2016 © Docplexus

Tuesday, March 08, 2016

Real Facts Behind The Myths About Vaccination In The General Population - WHO

What are some of the myths – and facts – about vaccination?

Online Q&A
April 2013

Q: What are some of the myths – and facts – about vaccination?

A: Myth 1: Better hygiene and sanitation will make diseases disappear – vaccines are not necessary. FALSE

Fact 1: The diseases we can vaccinate against will return if we stop vaccination programmes. While better hygiene, hand washing and clean water help protect people from infectious diseases, many infections can spread regardless of how clean we are. If people are not vaccinated, diseases that have become uncommon, such as polio and measles, will quickly reappear.

Myth 2: Vaccines have several damaging and long-term side-effects that are yet unknown. Vaccination can even be fatal. FALSE

Fact 2: Vaccines are very safe. Most vaccine reactions are usually minor and temporary, such as a sore arm or mild fever. Very serious health events are extremely rare and are carefully monitored and investigated. You are far more likely to be seriously injured by a vaccine-preventable disease than by a vaccine. For example, in the case of polio, the disease can cause paralysis, measles can cause encephalitis and blindness, and some vaccine-preventable diseases can even result in death. While any serious injury or death caused by vaccines is one too many, the benefits of vaccination greatly outweigh the risk, and many, many more injuries and deaths would occur without vaccines.

Myth 3: The combined vaccine against diphtheria, tetanus and pertussis (whooping cough) and the vaccine against poliomyelitis cause sudden infant death syndrome. FALSE

Fact 3: There is no causal link between the administering of the vaccines and sudden infant death, however, these vaccines are administered at a time when babies can suffer sudden infant death syndrome (SIDS).,. In other words, the SIDS deaths are co-incidental to vaccination and would have occurred even if no vaccinations had been given. It is important to remember that these four diseases are life-threatening and babies who are not vaccinated against them are at serious risk of death or serious disability.

Myth 4: Vaccine-preventable diseases are almost eradicated in my country, so there is no reason to be vaccinated. FALSE

Fact 4: Although vaccine preventable diseases have become uncommon in many countries, the infectious agents that cause them continue to circulate in some parts of the world. In a highly inter-connected world, these agents can cross geographical borders and infect anyone who is not protected. In western Europe, for example, measles outbreaks have occurred in unvaccinated populations in Austria, Belgium, Denmark, France, Germany, Italy, Spain, Switzerland and the United Kingdom since 2005. So two key reasons to get vaccinated are to protect ourselves and to protect those around us. Successful vaccination programmes, like successful societies, depend on the cooperation of every individual to ensure the good of all. We should not rely on people around us to stop the spread of disease; we, too, must do what we can.

Myth 5: Vaccine-preventable childhood illnesses are just an unfortunate fact of life. FALSE

Fact 5: Vaccine preventable diseases do not have to be ‘facts of life’. Illnesses such as measles, mumps and rubella are serious and can lead to severe complications in both children and adults, including pneumonia, encephalitis, blindness, diarrhoea, ear infections, congenital rubella syndrome (if a woman becomes infected with rubella in early pregnancy), and death. All these diseases and suffering can be prevented with vaccines. Failure to vaccinate against these diseases leaves children unnecessarily vulnerable.

Myth 6: Giving a child more than one vaccine at a time can increase the risk of harmful side-effects, which can overload the child’s immune system. FALSE

Fact 6: Scientific evidence shows that giving several vaccines at the same time has no adverse effect on a child’s immune system. Children are exposed to several hundred foreign substances that trigger an immune response every day. The simple act of eating food introduces new antigens into the body, and numerous bacteria live in the mouth and nose. A child is exposed to far more antigens from a common cold or sore throat than they are from vaccines. Key advantages of having several vaccines at once is fewer clinic visits, which saves time and money, and children are more likely to complete the recommended vaccinations on schedule. Also, when it is possible to have a combined vaccination, e.g. for measles, mumps and rubella, that means fewer injections.

Myth 7: Influenza is just a nuisance, and the vaccine isn’t very effective. FALSE

Fact 7: Influenza is much more than a nuisance. It is a serious disease that kills 300 000-500 000 people worldwide every year. Pregnant women, small children, elderly people with poor health and anyone with a chronic condition, like asthma or heart disease, are at higher risk for severe infection and death. Vaccinating pregnant women has the added benefit of protecting their newborns (there is currently no vaccine for babies under six months). Vaccination offers immunity to the three most prevalent strains circulating in any given season. It is the best way to reduce your chances of severe flu and of spreading it to others. Avoiding the flu means avoiding extra medical care costs and lost income from missing days of work or school.

Myth 8: It is better to be immunized through disease than through vaccines. FALSE

Fact 8: Vaccines interact with the immune system to produce an immune response similar to that produced by the natural infection, but they do not cause the disease or put the immunized person at risk of its potential complications. In contrast, the price paid for getting immunity through natural infection might be mental retardation from Haemophilus influenzae type b (Hib), birth defects from rubella, liver cancer from hepatitis B virus, or death from measles.

Myth 9: Vaccines contain mercury which is dangerous. FALSE

Fact 9: Thiomersal is an organic, mercury-containing compound added to some vaccines as a preservative. It is the most widely-used preservative for vaccines that are provided in multi-dose vials. There is no evidence to suggest that the amount of thiomersal used in vaccines poses a health risk.

Myth 10: Vaccines cause autism FALSE

Fact 10: The 1998 study which raised concerns about a possible link between measles-mumps-rubella (MMR) vaccine and autism was later found to be seriously flawed, and the paper has been retracted by the journal that published it. Unfortunately, its publication set off a panic that led to dropping immunization rates, and subsequent outbreaks of these diseases. There is no evidence of a link between MMR vaccine and autism or autistic disorders.

Related links