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July, 11 1998       06:57:49 PM
Dear Hastie(Netherland): Brittle , splitting , ridging, and longitudinal striations of the nails are probably signs of Onychomycosis(Tinea Unguium), a fungal infection of toe and fingernails.Usually will respond to systemic treatment with antifungal as Sporanox( Triazole-Itraconazole 100mg Capsule),You may take 200 mg twice daily for 12 consecutive weeks for toe nails infection, or 200mg twice daily for 1 week then 3 weeks without treatment followed by 200mg twice daily for an additional week if only fingernails are involved. It is advisable to have your Dermatologist obtain fungal culture from your nails prior initiation of therapy to confirm diagnosis. Therapy must be under supervision of a physician and may be taken with food and is contraindicated if pregnant or contemplating pregnancy . Nail pitting however along with Onycholysis (separation of nail plate from the nail bed) with a yellowish border "oil slick" is a diagnostic marker for Psoriasis or a periungual eczematous dermatitis variable and topical corticosteroids are the mainstay of therapy (Rx. Deproline or Valisone). Finaly fragile nails (fragilitas unguium) is a condition of architecctural abnormality where your nails are brittle due to excessive manicuring , frequent use of solvents to remove nail polish or often if you have your hands and feet in water. In that case an emollient hand cream to the cuticle although not curative may appear somewhat beneficial.Thank you for your consultation and please contact me if I could assist any further in your medical care.ELGENDY, MD.FAAP.

June, 06 1998       07:41:56 AM
Dear A.E/Saudi Arabia: LUPRON DEPOT PED ( 7.5mg monthly injections ), is a GnRH agonist, acts as a potent inhibitor of Gonadotropins which when given in theraputic doses will "Downregulate", suppress ovarian and testicular steroidogenesis. These effects are reversible on discontinuation of drug therapy. It's indicated in the treatment of children with Central Precocious Puberty ( Onset of secondary sexual characteristics earlier than 8 yrs in females or 9 yrs in males. Diagnosis must be confirmed by pubertal response to GnRH stimulation test & Bone age advanced one year than chronological age.It must be administered under the supervision of a physician and discontinuation should be considered before age 11 for females. Thank you for consultation.

May, 09 1998       08:03:03 AM
Dear ANC/Holland: Growth and development is what sets Pediatric apart from other specialities. It's particularly crucial to understand the basic concepts of Nutrition for children because it's the basis for good health, and also the driving force behind normal growth and development. The most sensitive indicator of the child health is "Growth Velocity", but linear shifting in the first 24 months of child's life may also be physiologic. A 24 months child should have gained about 12.5 cm above initial height which in average is about 50 cm at birth. Also Should triple their birth weight by 12 months of age, average weight gain is about 7Gm/day between 12-24 months and approximately 5 Gm/day between 24-36 months of life.It does decrease by age in children, except at periods of growth spurts in life. Children in age group between 2-4 years old are typically picky eater, rather more interested in physical activities and exploring their world around them , a simple developmental and physiologic stage where metabolic requirement and growth slows down. Caloric requirement is based on Basic metabolic rate (BMR) and activity level, practically speaking caloric requirements is about (1000Kcal+ 100Kcal x (age in years). RDA (Recommended Daily Allowance) for energy and protein for children (1-10) years of age is about 1300-2000 Kcal/day with a 1.2 Gm protein /Kg/day.In the first year of life a normal infant require about 120Cal/kg per day.In evaluating Nutritional need of a particular child , dietary recall is essential. It's of utmost importance for you to know that Individual growth trends after 18 month of age is physiologic, so as a healthy infant's height and weight proceed along a genetic potential, and Wt/Ht is a more sensitive measurement of nutritional status than Wt/Age.So a normal variable is a range of (80-110)% of IBW/Age. I think that Noorjie is a perfectly healthy child .> I would only provide some dietary recommendation beside allowing the child to be picky in order for her to develop a sense of taste for food * Pediasure (240 Cal/8 oz) once or twice daily as supplement. * Offer 3 meals and 2-3 snacks/day. * Eliminate excessive juices. * Add margarine to strained food and table foods. * Offer high caloric/protein foods. * Multivitamins with Iron for catch up growth. You should anticipate reasonable weight gain in approximately 7-14 days if you maintain an adequate and high caloric diet. Please make sure you plot her HT and Wt on her Growth chart using same scales and follow with her Pediatrician as needed. Thank you for your interesting consultation. ELGENDY, MD.FAAP.

May, 09 1998       08:03:03 AM
Re: my infant daughter sneezes.??
Dear Mohd:
sneezing is a normal physiologic reflex mechanism that is innate in infants, your one month old daughter seems to demonstrate that response quite clearly. Sensitization to inhalant antigens like perfumes may produce specific reaction that triggers the physiologic sneezing reflex to protect the infant upper airways from offending allergens. Occasionally that also could be a sign of allergic Rhinitis, especially if symptoms are recurrent and paroxysmal with recurrent exposure to perfumes at all time, this will be basically an immunologic reaction due to hypersensitivity, usually begin in the pediatric age group and often in the preschool period, however I doubt it's the case in your infant. Control of allergic symptoms should be directed primarily toward the avoidance of exposure to offending allergens, and that will often be sufficient to alleviate symptoms. I hope I have answered your question fairly......

May, 08 1998       07:19:05 AM
my daughter always got sneez specially when smellimg perfumes . thanks...

May, 06 1998       08:36:20 AM
Subject: Re: questoin to pediatric clinic Date: Tue, 5 May 1998 22:49:33 EDT
Dear Mohd:
The possibility of untoward bilogic effects of radiation is of special interest in Pediatrics since these effects may be most serious in growing tissues.The recommended occupational limit of maternal exposure to radiation for example from all sources is 500 milirads for the entire 40 weeks of pregnancy.Exposure of the entire body to 100 roentgens usually produce illness in human ( chest xry film in Newborn is 0.004 rads) Radiation absorption increases with the volume of the child's body exposed, with prolongation of exposure, or with an increase in amperage or voltage. Absorption decreases in relation to the effectiveness of filters used and with increase distance between the child and the radiation source..Specificaly to answer your question it is unlikley that exposure to computer and other emitting sources as light bulbs, television, microwave is significent ..providing adequate distance from sources is maintained since adverse acute effects of roentgen rays diminishes when the total dose is administered in several exposures