Rapid test for Norovirus

1) Norovirus( Electron-microscopic image, x 21,820)

2) Rapid test for Norovirus;

3) Rapid test for Norovirus;

Norovirus cause acute gastroenteritis and many outbreaks  in nursery, 
kindergarden, school, hospital and among families.

Previously names: Norwalk-like viruses, Caliciviruses, and Small round
-----------------------structured viruses.

1) Symptoms:  --  acute-onset nausea, vomiting; watery, non-bloody diarrhea 

---------------------with abdominal cramps, and fever.
2) Transmission: --oral-faecal route or a droplet route from vomitus.

----------------------Norovirus can survive freezing and heating to 60°C.
3) Incubation period: 12~36 hours

4) Disinfections: --1% sodium hypochlorite( Cl Na O) 

5) Rapid test: ------Enzyme-linked Immuno-sorbent Assay.
                            For more infomations, ask to -------　
ーーーーーーD Denka Seiken Co, Ltd.
                            http://denka-seiken.jp/english/index.html

                          ----------------------------------------------------
----------------------------                  --RT-PCR
--------------------　　　　　　---+-------- - ------ total
                          ----------------------------------------------------

                          rapid test---- +----53--------1---------54
------------                          --- - ----19-------90-------109
----------                          ------------------------------------------
-----                          --------total---72-------91-------163
                          ----------------------------------------------------

Any questions:   write to  Keiji Hagiwara,    

                             keijihagiwara@gmail.com

Intrafamilial transmission of Norovirus

Norovirus is one of the causative agents of acute gastroenteritis(vomiting and 
diarrhea) in childhood. If one child is suffered gastroenteritis due to this virus. 
Usually, brother or sister and their parents also are suffered, because no immunity 
to Norovirus.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A case of  intrafamilial transmission of Norovirus
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
April 23. 10-year-old male started abdominal pain and vomiting at school
-----------lunch time, following watery diarrhea.
April 25.  In the morning, Mother(45 y) and father (50 y) developed abdominal 
----------- cramp,vomiting and diarrhea.
-----------In the night, 15-year-old brother also started the same symptoms.

1) Rapid test of feces indicate Norovirus infection:

2) Electron-microscopic image of Norovirus:

Dennis Kunkel Microscopy. Inc.

3) Norovirus is still alive in the refrigerator freezer.
4) Disinfectants such as alcohol and Benzalkonium chloride( also known as  

---- alkyl-dimethyl-benzyl-ammonium chloride and ADBAC) is no effect.

---- Sodium hypochlorite, used for cleaning the baby's bottle, is effective.

Any questions: write to Keiji Hagiwara, MD
---------------------------------Kami-Ube Pediatric Clinic,
---------------------------------Ube 755-0097, Japan
---------------------------------keijihagiwara@gmail.com

Herpangina(mouth blisters)

Herpangina: small vesicles(pain+) in palate

                                 ----------------

                                 Herpangina

                                ----------------

1) Season: Summer

2) Age      :  infant and toddlers

3) Course of illness: fever and throat pain resolve few days or more longer.

4) Etiology: enteroviruses (coxsackie virus A or B, echoviruses)

Any questions:   write to Keiji Hagiwara, M.D.  

                                        Kami-Ube Pediatric Clinic, Ube 755-0097, Japan.

                                        keijihagiwara@gmail.com

Topical lotion for sweet rash

This drug has traditionally been prescribed in hospitals. But the number of children
with Miliaria have been decreasing, we have less chance for prescription.


Indications: sweat rash( Miliaria, prickly heat), heat rash, skin irritation and itching
Ingredients: Its main components are zinc oxide, phenol and diphenhydrazine(
                        anti-histamine).
　　1) Zinc oxide　　            30g 
　　2) liquid phenol　              5ml
　　3) Diphenhydrazine oil　 5g 
　　4) peppermint oil　         10ml
　　5) Ethanol 　　　           30ml
　　6) Glycerin                     100ml---------to 1,000 mL with sterile water 


Any questions:   write to Keiji Hagiwara, M.D.  
                                           Kami-Ube Pediatric Clinic, Ube 755-0097, Japan.
                                           keijihagiwara@gmail.com

Streptococcal infection: skin rash

6-year-old female came to Clinic with skin itching and fever.

Throat and tonsil were reddish, and rapid test for group A, β hemolytic streptococci was

positive ------ early stage of Scarlet fever. Oral antibiotics rapidly dissolved the symptoms.

6-year-old: tiny red skin rash with itching.

6-year-old: tiny red eruption with itching.

Any Questions:

Keiji Hagiwara, MD

Kami-Ube Pediatric Clinic,

Ube 755-0097, Japan

keijihagiwara@gmail.com

3.12. Fukushima nuclear plant disaster: Simulation of atmospheric dispersion of the radioactive plume

March 11th Earthquake and tsunami damaged the nuclear power plant at Fukushima,
where 4 of 6 nuclear reactors have been troubles, leaking the radioactive substances
to the air.

Institute de Radioprotection et de Sûreté Nucléaire(＝IRSN) has published information
on its french website regarding the status of the nuclear reactors at the Fukushima Daiichi
nuclear plant, and the consequences of the crisis.
         http://www.irsn.fr/EN/news/Pages/201103_seism-in-japan.aspx
          http://www.irsn.fr/EN/news/Documents/irsn-simulation-dispersion-en.pdf
It includes :
1) Dispersion of radioactive releases in the air
        http://www.irsn.fr/FR/popup/Pages/animation_dispersion_rejets_19mars.aspx
2) Whole body doses likely to be received by a one-year old infant with no protection
     during the releases
       http://www.irsn.fr/FR/popup/Pages/animation_doses_corps_entiers_19mars.aspx
3) Doses to the thyroid likely to be received by a one-year old infant with no protection
     during the releases
      http://www.irsn.fr/FR/popup/Pages/animation_doses_corps_thyroide_19mars.aspx


Thank you, French IRSN

Keiji Hagiwara, MD
Kami-Ube Pediatric Clinic,
Ube 755-0097, Japan
keijihagiwara@gmail.com

Rapid diagnostic test for influenza

Rapid tests for influenza virus infection: 

upper: influenza A

lower: influenza B

In Japan, rapid tests for influenza virus infection are routinely used by Physicians.
10 more products are marketing.

The sensitivities, when compared with viral culture, or reverse transcription 

polymerase chain reaction (RT-PCR)are approximately 85~98 %. 

The specificities are approximately 90~99%.

Both A and B are week positive: false results.

There are several sites to obtain the samples:
---------- 1) Nasopharyngeal swab: the best
---------- 2) Throat swab
---------- 3) Nasal swab

------------ New England Journal of Medicine -------

upper: classical cotton swab

middle: thin cotton swab 

lower: Tip flocked with Nylon fiber

Any questions: write to

--------------------Keiji Hagiwara, MD 

--------------------Kami-Ube Pediatric Clinic, Ube 755-0097, Japan.

Relenza: a inhalation drug for Flu

Zanamivir ( Relenza, GlaxoSmithKline) is a oral inhalation drugs, used in the treatment 
and prophylaxis of influenza caused by influenza A virus and influenza B virus. 

The recommended dose of RELENZA in adults and pediatric patients
aged 7 years and older is 10 mg twice daily (approximately 12 hours apart) for 5 days.
• Two doses should be taken on the first day of treatment
    whenever possible provided there is at least 2 hours between doses.
• On subsequent days, doses should be about 12 hours apart
    (e.g., morning and evening) at approximately the same time each day.

12-year-old boy, influenza A infection

10-year-old girl, influenza B infection

Any questions;   Keiji Hagiwara, 

                           Kami-Ube Pediatric Clinic, Ube 755-0097, Japan.

                           keijihagiwara@gmail.com

Funnel chest(hollowed chest)

Funnel chest (hollowed chest)

Pectus excavatum (hollowed chest)is the most common congenital deformity of
the anterior wall of the chest.

The Nuss procedure is a minimally-invasive procedure, invented by Dr. Donald
Nuss (Children's Hospital of The King's Daughters, in Norfolk, Virginia) for
treating pectus excavatum. 

A concave stainless steel bar is slipped under the sternum, through the incisions
in the side of the chest. The bar is then flipped, and the sternum pops out.

To support the bar and keep it in place a metal plate called a stabilizer may be
inserted with the bar on one side of the torso.

After a period of two to four years, the surgical stainless steel bar is removed
from the patient's chest.

Any Questions: write to
Keiji Hagiwara, MD
Kami-Ube Pediatric Clinic,
e-mail: keijihagiwara@gmail.com

Minimum Inhibitory Concentration( MIC test)

MIC test:Tube method

MIC test: Micro titer method

-------- from the homepage of Antimicrobial Test Laboratories

MIC(Minimum inhibitory concentration) is the lowest concentration(μg/ml) of an
antibiotics that inhibit the growth of a bacteria.

A bacteria are culturing in wells or tubes, while an serial dilution of an antibiotics are
adding each tubes or wells for overnight. Cloudy tubes or wells indicate the growth
of bacteria. Clear wells or tubes indicate the inhibition of a Bactria's growth.


Any Questions: write to
Keiji Hagiwara, MD
Kami-Ube Pediatric Clinic,
e-mail: keijihagiwara@gmail.com

Kirby-Bauer antibiotic testing (disk diffusion)

Staphylococcus aureus

Left：Aztreonam disc(30μg/ml).

Right：Vancomycin disc(30μg/ml)

--------Dr. Mizuno, Clinical Laboratory, Yamaguchi University School of Medicine

Kirby-Bauer antibiotic testing (disk diffusion) is a test for determine which antibiotics
is susceptible to a bacteria. A bacteria(Staphylococcus aureus) are grown on agar
plates, while the small discs(containing antibiotics: Aztreonam or Vancomycin) are
placing for overnight. Clear zone indicate the inhibition of a bacteria's growth.

Any Questions: write to
Keiji Hagiwara, MD
Kami-Ube Pediatric Clinic,
e-mail: keijihagiwara@gmail.com

Exanthema subitum( Roseola)

Clinical course of Roseola (Exanthama subitum)

---------------------------------------
Roseola= Exanthema subitum
---------------------------------------
This disease may suffer 2/3 of the Japanese child.

Etiology: human herpes virus - 6.

EM image : x 25,000(Dr. Kazuto Yamaguchi,Department of Animal

Experiment, Yamaguchi University School of Medicine)

Age: 3 months to 3 years (frequently 7 months~ 1.5 years)

Clinical course:

||||||||||||||||||1) high fever(39~40℃) last for 3~5 days.
||||||||||||||||||||||| but child do not seem very sick.
||||||||||||||||||2) no cough, no runny nose( frequently, loose or watery stool) .
||||||||||||||||||3) a fever subside, then a red rash appear in body.
||||||||||||||||||||||||The type of rash is variable; Rubella like~Measles like~
||||||||||||||||||||||||or diffuse pink rash. Rash disappear in several days.


Complication:
|||||||||||||||1) febrile convulsion
|||||||||||||||2) encephalitis (rare)

Questions ? -------  write to keijihagiwara@gmail.com

Measles: An epidemic of Measles in Yamaguchi, 1991.

1) An epidemic of Measles in Yamaguchi Prefecture:
---In the past, an epidemic of Measles was noted in 1991(the peak was May) in
---Yamaguchi Prefecture (Population=1,560,000).

--------------------------- Reported numbers of Measles in Yamaguchi from 1991~1993.

---------Since then, no epidemics were occurred, except for small outbreaks, 

--------- in Yamaguchi prefecture.

2) The complication of Measles:

----Here, an example of the Measles's cases, who were hospitalized at Yamaguchi

--- University Hospital in 1991, with;

--------------- i) Pneumonia: 17 cases ( one case needed artificial ventilation)

-------------- ii) Encephalomyelitis: 5 cases

------------- iii) Croup: one case

------------- iv) Febrile convulsion: one case

Measles: 16 year old

~~~~~~~~~~~~~~~~~~
Measles: 16 year old boy
~~~~~~~~~~~~~~~~~~
He received Measles vaccine at 1 year old. So in this case, vaccine immunity
was disappeared.


1991.
January 14: started fever
----------15: high fever
----------16: high fever
----------17: Skin rash appeared from face, then upper trunk and extrimity.
----------18: Hospitalization. WBC 2,700(44%band. 22%seg, 20%lym.14% mon)，
--------------- CRP=3.3mg/dl
----------19: high fever, cough. Skin rashes appeared all over the body.
---------------------------------------But conjunctivitis was not severe.
---------------------------------------taken the photos;
-----------------------------1) Face:

-----------------------------------2) chest;

------------------------3) chest: enlarged

----------------------4) Koplik's spot: not so clear one.

----------------- January 20th:  skin rash of the arm.

        
------------------January 26:  skin pigmentation of arm. 10 yen coin for reference.

Measles:4 year old

Here show the case of Measles : 4 year old.

-----------Day 1:  fever start

ーーーーDay 2:  fever, cough and nasal discharge.

ーーーーDay 3:  Koplik spot appeared at night.

ーーーーDay 4:  Skin Rash appeared at Face.

ーーーーDay 5:  Rash from upper trunk and extremity to lower. 

------------------- WBC 7,000(Lym39%, Mon9%, Seg 45% ,Band7% ), CRP 0.43mg/dl.

ーーーーDay 6:  peak of Rashes.

ーーーーDay 8: no fever.  WBC 5,900(Atypical cells 36%, Lym 44%, Mon2%, Band5%, ーーーーーーーーーEos4%)

ーーーーDay 9: skin pigmentation.

Measles

I have seen no patients with Measles since 1999. In April, 1997, I opened
my clinic and only 3 infants with Measles until 1999.



What is Measles?

1) Etiology:  Measles virus

2) A typical case of measles begins with fever, cough, runny nose, red eyes, 

------- and sore throat.  2~3 days after, tiny white spots (Koplik’s spots) may

------- appear inside the mouth.

------- 3~5 days after, a red or reddish-brown rash appears. 

------- The rash usually begins on a person’s face at the hairline and 

------- spreads downward to the neck, trunk, arms, legs, and feet. 

------  When the rash appears, a person’s fever may spike to more than 

------- 104 degrees Fahrenheit.

------- After a few days, the fever subsides, the rash fades and 

------- skin pigmentation appear.

3) Clinical course of Measles:

麻疹＝Measles, 体温=Body Temperature, 発疹=skin rash，

コプリック斑=Koplik's spots,  結膜炎=conjunctivitis

はなかぜ=nasal congestion，せき=cough

4) Complications: 

------ i)  Pneumonia:  frequently in infant. usually, caused by bacteria

-------------------------such as H. influenzae or streptococcus pneumoniae.

------ ii) Otitis media: freuently in infant and toddler.

------ iii) Croup: acute laryngitis.

------ iv) Measles encephlo-myelitis: 6~15 year old are at risk.

---------- usually occur in recovery phase. Urinary and walking disturbance

---------- are the early sigh. Don't worry . Most cases recover without of 

-----------neurological sequerae

------ v)  Encephlitis:  1/1,000

------ vi) keratitis:  infant in the countries with vitamin A deficiency

------ vii) SSPE:  vary rare

Here, show the old photos of Measles:

1) high fever, cough, eye dischrges and skin rash:

2) Koplik's spot: look like candida infection.

3) skin pigmentation.

Hand, Foot, and Mouth disease

April 30th. 3-year-old boy came to my clinic.
--------- Hand-Foot- Mouth disease is small epidemic in a kindergarten.

Usually this disease is epidemic in Summer.  Recent weather in Ube city, 
is unpredictable; one day---- summer, next day---- autumn----- 
hot summer ------ .

1) Hand: small vesicles with no itching and no pain.

2) Foot:

3) Mouth:  sores(+) ------ cause pains---- sorry no photos.