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

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.

Pinwheel

Pinwheel: a windmill toy

Windmill in Kinderdijk

blowing a pinwheel

While children is blowing a pinwheel toy （風車 Kaza-guruma in Japanese),
you may easy to hear the sound of the bronchi or lung.

From autumn to winter, the infant and toddler often suffer from wheezing
(Asthmatic) bronchitis. Using windmill toe, you never miss.

Any question: write to Keiji Hagiwara, M.D.
                                   Kami-Ube Pediatric Clinic
                                   keijihagiwara@gmail.com

Vaccine injection technique: Japan-US differences

-------- from the homepage of CDC

Two types of vaccine injection techniques ( Intramuscular or subcutaneously) 
are routinely used In United States.

----------  Intramuscular   :  Influenza, Haemophilus influenzae, Pneumococcal, -----------------------------------                    DTaP, Hepatitis-B, Hepatitis-A.

---------- Subcutaneously:  IPV(Polio), MMR, Varicella

In Japan, all vaccines are administered by subcutaneously.

Any questions ?

--------------- write to Keiji Hagiwara.  keijihagiwara@gmail.com

Drug preparations for children

There are several types of powder drugs such as granules, dry syrup for children
and liquid medicines are also available.

Basically, Drug dosages are calculated by body surface area or body weights of
each children. 　

Roughly, drug dosages of child -----------
----------------12 year old : 2/3 of adult
-----------------7 year old : 1/2 of adult
-----------------3 year old : 1/3 of adult
-----------------1 year old : 1/4 of adult

Mini-Pharmacy in my clinic

This machine can do 21 packages at one time. 

Electronic Toploading Balance( Right, weight range =2g~500g,

readability=0.01g ).  A samples of divided ones(Left)

Liquid medicines for children.

Any questions: write to Keiji Hagiwara, MD   

                                         keijihagiwara@gmail.com

An epidemic of Swine Flu in children at Ube-Onoda area

In Ube city, an epidemic of swine flu was started among elementary school pupils

(aged 10~12 year old), and then spread to older or younger ages. The peak was 48 week((November.23~29,2009).

1) Influenza case is defined as positive in Flu symptoms & rapid influenza antigen test.  

----all reported cases, except for very few cases of B(+),  is A(+)positive and were not 

---- confirmed by PCR.

2) Cases are reported from pediatricians of Clinics and Hospitals in Ube-Onoda area,

----(Total pop.= 210,000. less than15 year old=29,000) Yamaguchi, Japan.

3) week 40 (Sep.28~Oct.4, 2009)
               week 41 (Oct.5 ~ Oct.11)
               week 42 (0ct.12~Oct. 18)
               week 43 (Oct.19~Oct.25)
               week 44(Oct.26~Nov.1 )
               week 45(Nov.2~Nov.8)
               week 46(Nov.9~Nov.15)
               week 47(Nov.16~Nov.22)
               week 48(Nov.23~Nov.29)
               week 49(Nov.30~Dec.6)
               week 50(Dec.7~ Dec.13)
               week 51(Dec.14~Dec.20)
               week 52(Dec.21~Dec.27, 2009)
               week 53(Dec.28~Jan.3, 2010)


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

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The injection technique of Swine influenza vaccine

In Japan, Swine flu vaccine is made by

1)The Kitasato Institute Reseach Center for Biologicals  
    → http://www.kitasato.ac.jp/rcb/eng/index.html

2)The chemo-Sero-Therapeutic Research Institute 

        → http://www.biken.or.jp/english/index.html

and other companies.

For more infomation, Please ask the companies.

The injection technique of vaccine;
1) Inject into subcutaneously, not intra-muscularly in Japan.
     Other vaccines(DaPT, Measles & Rubella, Varicella, Mumps,
      Japanese encephalitis ) are also administered via the same route .
2) The site of vaccine injection is upper arm(skin just above 
    Triceps brachii muscle, avoid the radial nerve), not thigh or 
     buttock.

------------------------   from Wikipedia(http://en.wikipedia.org/wiki/Triceps_brachii_muscle)

3) Use the 27 gauge needle(for the tubelculin test) .
4) Before injection, vaccine liquid( 4 ℃) is warmed up to room temperature.
     Cold liquid will triger the pain reaction.
5) Inject slowly. Rapid injection also induces pain.

subcutaneous injection of Swine Flu vaccine(1)

subcutaneous injection of Swine Flu vaccine(2)

subcutaneous injection of Swine Flu vaccine(3)

In USA, swine(2009 N1H1) influenza vaccine is administered via intra-
muscular route, or by intra-nasal spray(may be the same in Europe).

　intramuscular Flu vaccination in the left shoulder muscle

    (from the website of Centers for Disease Control and Prevention

      ➞ http://www.cdc.gov/  )

Any questions: write to keijihagiwara@gmail.com
                                            Keiji Hagiwara, MD.
                                            Kami-Ube Pediatric Clinic,
                                             1-20-2 Tokiwadai,
                                             Ube 755-0097, Japan.

Automatic blood cell counter

I purchase the new automatic blood cell counter. because the breakdown
of the former machine, which worked for 12 years.

--------------------------------LC-660(not sold in USA), HORIBA, Ltd.
　　　　　　　　　              　→ http://www.horiba.com/us/en/
Using 10 micro-litter whole blood, you can measure WBC, RBC,
Hgb,HcT, Platelet and the percentages of lymphocyte, monocyte,
and granulocyte. it take only one minute.

Any questions: write to keijihagiwara@gmail.com

Atopic dermatitis(2 year old)

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

Atopic dermatitis( 2-year-old )

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

Here a typical case of Atopic dermatitis.

2-year-old boy. Skin rash appear in face, neck, trunk, arm and leg.

Only show the photos of hand, thigh and foot.

------------------------ Red, irritated, raised rash at left thigh.

Lab. data):

|||||||| Serum IgE 356 iu/L.

|||||||| white blood cells 15,800/mm3. Eosinophil 9%.

|||||||| Allergen test for egg white (+4/6), cow milk( +4/6), ovomucoid(+3/6),

|||||||| ----------wheat(+2/6) , dogs(+3/6), cat( 0/6), mites(o/6), house dusts(0/6).

-------------------------- Left foot: He frequently have been scratched the skin

-------------------------- and worsen the dermatitis------ negative feedback.

-------------------------- 6 days after treatment.　

Any questions: write to Keiji Hagiwara, MD

keijihagiwara@gmail.com

Thermometer (old & new)

It was often a troublesome thing to measure the body 

temperature of children. It took 10~15 minutes in old one.  

Thanks to the advance of microelectronics.  Now it take 

few minutes.

This is a Ear thermometer(OMRON). To measure the 

body temperature, just inserting the ear canal.  

This device can measure the temperature of tympanic 

membrane, using the refraction of infra-red beam.  

But not for suitable in child, since the ear canal of children 

is narrow and often difficult in infants.

Any question: write to keiji Hagiwara, M.D.

                                         keijihagiwara@gamil.com

Egg allergy and influenza vaccine

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

A case of Egg allergy

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

Flu or Measles vaccines can not be vaccinated in the child

who have egg allergy. To make influenza vaccine, eggs are

used to propagation of influenza viruses and it is quite

difficult to remove the residue of egg proteins.

Don't worry ! Egg allergy is resolved in accordance with age.

Here, I show a case.

November 2000.

one-year-old boy with egg allergy came to my clinic.

He experienced the urticaria after eating egg.

IgE antibody titers to egg white(+2/6), egg yellow(0/6)

➞ Intradermal injection test:

❏ influenza vaccine solution(1/10 diluted with saline)

----- 0.1ml 15x17 mm reddishness & wheal.

❏ saline ---- 0.1ml 5x5 mm.

→ stop the injection of influenza vaccine.

January 2001. (2-year-old).

➞ Intradermal injection test;

❑ Measles vaccine(1/10 dilution) 0.1ml ---- 2x2 mm

❑ Control(saline) 0.1ml ---- 2x2 mm

→Injection of Measles vaccine resulted no problems.

August 2004. (4-year-old).

IgE antibody titers to Egg white(0/6). Mites(+6/6)

House dusts(+6/6).

November 5th, 2004. (5-year-old).

Influenza vaccine was administered, and no side effects.

November 19th. second shop of Flu vaccine. no problems.

Any questions: write to Keiji Hagiwara, MD

keijihagiwara@gmail.com

Bone fracture

Photo: Fracture of bone(radius). 1 year & 5-month-old boy.

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

Bone fracture

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

When the boy overturned, his left arm hit the ground.

The swelling & reddishness of left arm were noted.

The X-ray showed the fracture in the middle portion

of radius bone.

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

E-mail: keijihagiwara@gmail.com

Belches in newborn infant

newborn 16-day-old.  distention of intestine due to air injections

 Photo: 1 month old neonate. X-Ray show the distention

---------of stomach due to excessive ingestion of Air.

-------- ( note the thymus shadow of upper lung)

Figure) A method to induce belches .

The neonate frequently drink airs during breast or bottle feeding
and have difficulty in belches. So after feeding, Please induce belches 

Any questions: write to Keiji Hagiwara, MD

keijihagiwara@gmail.com

X-Ray system in Pediatric practice

Photo)  X-Ray system in my Clinic---made by SHIMADZU              

             corporation. Her right hand hold the protector for

             preventing the radiation to reproductive systems 

             of child.

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

X-Ray system 

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

 

Is it necessary to have a X-Ray apparatus in Pediatric Primary 

Care Clinic ?    If doctor is well trained and good experiences, 

the answer is NO.

It is difficult to take good X-Rays in child. For instance, Chest

X-Ray is shot at deep inspiration phase. But child can not hold 

the respiration.  So by chance. 

The point to take a good X-Ray is the fixation of child's body 

by mother or father and a staff.  At least two persons are

needed to fix an infant.

In 1895, Wilhelm Röntgen discovered X-Ray. Then one year 

later, Umejiro Shimadzu assumed the name of his father, 

Genzo Shimadzu, the founder of SHIMAZU Co., and in 

cooperation with his younger brother, succeeded taking 

roentgenograms for the first time in Japan. 

  →  http://www.shimadzu.com/products/medical/oh80jt0000001x6x.html

Any questions:  write to Keiji Hagiwara, MD                          

　　　　　　　keijihagiwara@gmail.com

Butterfly Needle: old and new

Photo:   butterfly needles for Drip infusion. 

Upper one is old one, which is difficult to preserve several 

days, especially in infant and toddler.  

Lower one (new version available from Becton Dickinson)

is suitable to newborn and infant's Fluid infusion therapy 

for many days.