ONLINE WARDROUNDS (Ep 3): featuring CASE REVIEWS & SPECIAL INTERVIEW OF DR. @ENDOPEDIATRIA
Steem Medics,
#AIR-CLINIC ROCKS! It’s good to be back with another interesting episode of Online Ward rounds, a special programme for medics on the blockchain. It is a part of @Air-Clinic's sub-project, SMSI (steem medics support initiative). We are sure you had a great time during the first episode. For those that missed the show, here is a link to the second edition
ATTENDANCE REGISTER (LAST WEEK).
These are the steem medics that graced our grand rounds last week:
- Dr. @Nairadaddy (a GP)
- Dr. @Antigenx (a GP),
- Dr. @Thelovejunkie (a practicing dentist),
- Dr. @Elvigia (a practicing ENT Surgeon)
- Dr. @Omaqiin (a general practitioner),
- Dr. @Endopediatria (pediatric endocrinologist),
- @Drqamranbashir(a GP),
- @tamala,
- @ali.asadi
- @zyled
- @zoneboy (our special guest)
You all made our second episode a success. We appreciate your contributions.
@air-clinic specially appreciates @zoneboy
Thank you for honoring our invite. It was great having you on the show.
Here is a quick summary for last weeks cases
Case 1 Highlilghts
Endometriosis is a disorder in which hormonally responsive endometrial tissue is found outside the uterus. Histology reveals endometrial glands and stroma, macrophages laden with hemofuscin and hemosiderin, as well as fibrosis.
Case 2 Highlights
Brucellosis is a zoonosis and often occurs in workers in close contacts with animals or carcasses. Otherwise spread is largely by ingestion of raw milk from infected cattle or goats.
FOR THIS WEEK , HERE ARE THE CASES FOR YOU TO ATTEMPT.
Case 1
A 3weeks-old presents with projectile vomiting, the baby appears hungry after each emesis. On examination, she is dehydrated and there is an abdominal mass.
- What is your diagnosis? (And what is the basis for making your diagnosis?)
- What are your DDx?
- How would you work up this patient?
- How would you manage this patient?
Case 2
A baby has a number of fits, each occurring in the morning on four consecutive days. On physical examination you find the liver to be enlarged. The fasting blood sugar is low and the uric acid is high
- What is your diagnosis? And what is the basis for making the diagnosis?
- What are your DDx
- How would you work up the patient?
- What are your management modalities for this case?
Case 3 ( Seen recently by our guest for the week in practice)
A girl 7 years old goes to pediatrician office with a runny nose and cough. During pharyngeal examination., a mass/ tumor measuring about 1 cm is observed in the base of the tongue.
- What is your diagnosis? And what is the basis for making the diagnosis?
- What are your DDx
- How would you work up the patient?
- What are your management modalities for this case?
Remember to approach these cases from your professional point of view.
BENEFITS OF SMSI
- As the name implies this is strictly to assist steem medics on their steemit journey.
- Support will be in the form of community of mutual interests.
- Qualification verification to improve the quality of steem healthcare.
- Upvotes and post -curation for verified members.
- Get part of the rewards for participating in Online Ward rounds.
- Engaging discussions will be held intermittently to listen to our individual journey on the path of health.
- Problem-solving and family bonding.
TETE-A-TETE (INTERVIEW SEGMENT):
*For this week’s TETE-A-TETE segment, meet our guest... - Dr. @Endopediatria (pediatric endocrinologist)
Tell us about yourself
My name is Joalice Villalobos and I’m Pediatric Endocrinologist in Maracaibo, Venezuela. I founded two Diabetes and Endocrinology Units in public and private hospitals in my city. I work with a team whom I’m very proud. I teach pediatric students at the University for free.
I’m a wife and mother two new graduated youths, one is a Physics Scientist and another Electrical Engineer.
Why you love airclinic
I knew @air-clinic through an @leonellaforever post where she invited to Spanish community. I take part actively in Spanish discussions. My maternal language is Spanish so I write Spanish posts, some of them in English too.
I think that @air-clinic is a wonderful project with high potential, still in developing. Where we have the opportunity to share health topic with colleagues and community in general without matter where you live.
Hight and low point on steemit
I began in steemit because I read a @cembot (my son) post. It was very difficult for me, I didn’t understand a lot of things until I discovered discord and I knew several people that gave me a lot of advice. Maybe some of my best posts were seen for nobody.
My first exciting moment was when I was voted by @ocd with very nice comments, the second time when @antigenx contacted me for this interview.
Challenges/survival story in your specialty
When I returned from my postgraduate course to my city I found a lot a problems to attend children with diabetes. There were not an adequate office, educator, psychologist... I decided to make a project and knock a lot of doors to find the founds till the 2008 year that we could found a unit in a public hospital with 5 offices, education area, meeting area, waiting area. Besides we could gather nutritionist, psychologist, 2 educator nurses and 4 endocrinologists. I felt a dream come true. We began with 22 children and reached 178. But now the challenge continues because my country is in crisis and we have lost a lot of health workers and right now we are only 2 endocrinologists and 1 nurse. But we are still here fighting for our needed people.
Motivation to study your career.
I decide to study pediatric endocrinology when I knew a family with a girl with congenital hypothyroidism. I had de opportunity to see her recovering with substitutive treatment, but she remained with some grade of mental retardation because her diagnosis was late. I decide to make the difference.
Final words
Every doctor is a leader in his community, but our community is not only around we live, we belong to a globalized world and we can make the difference beyond.
OTHER INITIATIVES THAT "Steem-Medics" WILL BENEFIT FROM.
#AIR-CURIE: is an initiative powered by @Air-Clinic aimed at finding and rewarding quality medical posts. We also submit to giant curators who may further reward posts.
#Leading-HEALTH-TALKS: every true health professional/student desires to share their knowledge of medicine and the human body with others. We engage #steem medics in the affairs of @Air-Clinic.You get the opportunity to share knowledge according to your interests and specialty.
- All interested Steem Medics who would love to be a part of this support initiative should join @Air-Clinic on DISCORD.
See link here: https://discord.gg/rqded5m
Don’t forget to share your interesting case with us; it may be used for a review in our next episode.
We are here for your health!
This article was compiled by @antigenx for @air-clinic
KINDLY UPVOTE & RESTEEM TO REACH MORE MEDICS.
KINDLY UPVOTE & RESTEEM TO REACH MORE MEDICS.
I will attempt case #2:
The child has Glycogen Storage Disease type I
The "fits" exhibited in the morning are seizures caused by hypoglycemia. The elevated uric acid and hepatomegaly would also lead to that diagnosis.
Additional tests: triglycerides, lipids, cbc, gamma glutamyltranferase, ketone bodies, ultrasound liver & kidneys.
Treatment: to maintain normal glucose levels throughout the 24 hour day. Feedings every 3-4 hours with cornstarch, avoid
carbohydrates with galactose or fructose. Adequate protein and fats.
*Disclaimer: I am not a doctor and I do not play one on the internet. I am however, really enjoying the learning experience on air-clinic!
Definitely a glycogen storage disease. Your diagnosis is very appropriate for the presentation. If we are to go with this 'tentative ' diagnosis, what other disorders would the child face apart from hypoglycemia and how would you manage them?
And why do u keep giving this disclaimer? What is your career specialty ? #just curious 😋 @tamala
@antigenx I'm a health coach with an insatiable interest in medicine. Is it ok if I still participate?
@tamala im impressed, you are doing very well my dear. #kudos.
I value your inputs....😎
For case 3,I will think of nasopharyngeal carcinoma with differential of rabdomyosarcoma, because of location, size of the mass and age of the the patient.
My treatment modality will include laboratory examination like complete blood count, then biopsy and histology and may be CT/MRI if there are other features suggestive of metastasis.
My mainstay of treatment will be radiotherapy.
For case one i think i will need further history and examination, like the exact location, character of the abd mass, and abd scan.
I would rather seek the input of Dr @endopediatria in this particular case management , with her experience in the field of pediatrics and also an erudite lecture in the field i believe she had a first hand experience with the patient.
@omaqiin im curious to know why you are sticking with nasopharyngeal carcinoma?
Can you give reasons ..
@omaqiin in healthy children the first probable diagnosis is ectopic thyroid as explain @elvigia. In this case was confirmed with thyroid gammagram. Her thyroid tests were normal. Of course carcinoma is a diffetential.
Thanks to @antigenx for interview. I'm happy for the opportunity to belong at this community.
Comments about case 1.She could have pylorius congenitl hypertrofy, although it is more frecuent in boys, but cronology fits. Differential diagnosys are intestinal obstruction and sepsis. In case of genital ambiguity could be
congenital adrenal hypertrophy.
We need hemogram, electrolites, gasometry and abdominal ultrasound.
Case 2 looks like glycogenosis, an infant with hypoglycemia and hepatomegaly, without infection, is the diagnosis most probable. To support the diagnosis he would have hypertrigly ceridemia and inadequated respons to subcutaneum glycagon.
i would want to thank you for honouring my request to be on the show. @air-clinic is also glad.
Your 'diagnosis' are in order , same with the DDx
I´m very happy for you interview @endopediatria. Congratulations.
You are next😋
Thanks!
Hi.
Case 1
It is a pyloric stenosis.
I am based on the fact that in this pathology, there is a thickening of the pylorus muscles and they acquire an abnormal size and prevent the passage of food to the small intestine and therefore the children vomit in projectile, they are hungry, dehydrated and do not gain weight. The diagnosis is made through a barium x-ray and an ultrasound
The resolution is surgical.
Case 2
In a baby with hypoglycemia and palpable liver, you should think about a glycogenesis. This is a hereditary disease and there is accumulation of glycogen in the liver and kidney and this explains the low levels of glycemia and high levels of uric acid. How is not my area I would send it to the child endocrinologist.
Caso 3
In this patient I would think of an ectopic thyroid, because it has no troublesome symptoms in the oropharynx and the base of the tongue is the most common situation of thyroid ectopia.
I would perform a thyroid gammagram and would have to keep it in control simply with thyroid tests.
I love the steps you took to arrive at your diagnosis @elvigia. Its very simplified and a pre-clinical student can become a doctor just reading through...
You are very much on track.
This is going to be quite interesting this week. Nice having Dr. @Endopediatria on this show. You are a great person with a heart of gold.
As for the cases, they are a bit specific to the pediatric sub-specialties. Lolx. Case 3 though; I'm thinking of Epiglotitis since its a single mass. The picture needs to be painted further. Like does the child have fever, difficulty with swallowing etcz. Differentials may include Tonsilitis.
Let's do an XRAY of the neck region or MRI to delineate the mass properly. A throat swab for MCS should come in handy.
Management is majorly with appropriate antibiotics.
Welldone @Antigenx for hosting this.
Thanks @nairadaddy. In fact the girl just had flu withuot fever. It was an incidental find. In a next post I'll show the picture. Of course the differentials are infectious diseases too.
Hey everyone, awesome inputs by you all and I wouldn't disagree less with @endopediatria as she is a specialist with kids. I am particularly interested in Case 3 which has its presentation in the mouth. My Diagonsis will Common cold (because common things occur commonly) which should be treated but then, an incsional biopsy should be done for the swelling to rule out carcinoma. Ddx will be Tonsillitis, Ranula