Diseases Caused by Epstein Barr Virus

Epstein barr virus is a DNA virus of family Human Herpes Virus. It is also known as HHV-4 or Human HerpesVirus 4. It is ubiquitously present and infects around 90% of world population generally resulting in mild to asymptomatic flu like symptoms.

Infections

It causes infectious mononucleosis or glandular fever in the adolescents.  It is transmitted by saliva and infects the epithelium of nasopharynx and oropharynx and subsequently enters B cell to infect it. It manifests as pharyngitis, cervical lymphadenopathy, fatigue and fever.It is transmitted with kissing and hence is known as Kissing disease.

Cancers

First known virus to cause cancers to human was EBV affecting epithelial cells, mesenchymal cells and lymphocytes. It affects all immunocompromised and immunocompetent hosts or those with acquired iatrogenic immunosuppression. Gastric Adenocarcinoma, endemic  Burkitt Lymphoma, Hodgkins Lymphoma, large B cell lymphoma, Nasopharyngeal Carcinoma has been associated with HHV4.

Autoimmune diseases:

High viral EBV has been found to be associated with SLE and its flares. Similarly, high amount of  EBV infected B cells have been found in Synovium and joints of patient affected with Rheumatic Arthritis. Antibodies directed against EBV has been found in patients with Sjogren Syndrome and they have been found to have higher incidences of lymphoid malignancies like MALT, Non hodgkin's Lymphoma. 

EBV has been found as an environmental trigger in the development of various Systemic Autoimmune disease.

Lymphoproliferative diseases associated with HIV

EBV when occurs simultaneously with HIV, it predisposes to various lymphoproliferative diseases. It is mostly secondary to immunosuppression and are of B cell origin. About half of HIV defining cancers are associated with EBV like Hodgkins Lymphoma, Burkitt lymphoma, diffuse large B cell Lymphoma, peripheral T cell Lymphoma but more specific and  associated with HIV with EBV include Plasma Blastic lymphoma (PBL) of oral cavity, Primary effusion lymphoma (PEL), HIV related CNS lymphomas.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766599/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314581/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346501/

http://www.ijcem.com/files/ijcem0012377.pdf

List of All named Hernias (Hernia Eponyms/Special Hernia)

Hernia is the abnormal protusion of a viscous or a part of it through an opening with a sac covering it. It could either be internal or external and not necessarily from the abdominal cavity. The most commonly encountered are the inguinal hernias and femoral hernia. But there are certain hernias that are named and arise from its specific location or contain specific content.

Hernia Eponyms on the basis of their similarity with the adjacent ones

Name of Hernia	Description
Bochdalek’s Hernia	Congenital Posterolateral Hernia of Diaphargm
Morgagni Hernia4	Through Larry’s space in Diaphargm
Larry’s Hernia4
Gibbon Hernia	Hernia with Hydrocele
Bergers Hernia	Hernia in Pouch of Douglas
Romberg Hernia1	Concurrent Ipsilateral Direct and indirect Inguinal Hernia
Saddle Hernia1
Dual Hernia1
Lumbar Hernia	Hernia in lumbar triangles of type Petit’s and Grynfelt
Obturator Hernia	Hernia through Obturator Canal
Grynfelt Hernia	Upper Lumbar triangle Hernia
Petit’s Hernia	Lower Lumbar Triangle Hernia
Femoral Hernia	Hernia medial to Femoral Vein in Femoral canal
Cooper’s Hernia6	Femoral Hernia with two sacs
Bilocular femoral Hernia6
Cloquet’s Hernia	Hernia Through Pectineal aponeurosis
Callison-Cloquet Hernia	Through Pectineus Muscle and its fascia
Narath’s Hernia	Behind Femoral Artery in congenital dislocation of Hip
Hesselbach’s Hernia	Lateral to Femoral Artery
Serofini’s Hernia	Behind Femoral Vessels
Laugier’s Hernia	Through Lacunar Ligament
Teale’s Hernia5	In front of Femoral Vessels
Velpeau Hernia5
Richter’s Hernia	Part of circumference of bowel wall is entrapped
Littre’s Hernia	Contains Meckel Diverticulum
Sliding Hernia	Hernia with a part of the wall formed by the viscus
Hernia En Glissae	Hernia with a part of the wall formed by the viscus
Maydl’s Hernia2	Two loops of bowel in Hernia sac with remaining part in abdomen
W Hernia/Hernia in W2
Retrograde Hernia2	Two loops of bowel in Hernia sac with remaining part in abdomen
Phantom Hernia	Localised Muscle Bulge following Muscle Paralysis
Mery’s Hernia7	Through the perineal floor
Perineal Hernia7
Spigelian Hernia	Hernia through Speligian Fascia
Sciatic hernia	Hernia through greater or lesser sciatic foramen
Little’s hernia3	Appendix in inguinal  Hernial Sac
Amyand hernia3
De Garengeots Hernia	Incarceration of appendix within Femoral Hernia
Beclards Hernia	Femoral Hernia Through Saphenous Opening
Barth’s Hernia	Hernia Between Adbominal wall and Persistent Vitellointestinal Duct
Holthouse’s Hernia	Inguinal Hernia That has turned outward into the groin
Grubers Hernia	Internal Mesogastric Hernia
Mesocolic hernia	Transmesenteric Hernia
Kronlem Hernia	Inguinoproperitoneal Hernia
Trietz Hernia	Paraduodenal Hernia
Rieux Hernia	Retrocaecal Hernia

Hernia Eponyms in alphabetical order

Name of Hernia	Description
Amyand hernia3	Appendix in inguinal hernia Sac
Barth’s Hernia	Hernia Between Adbominal wall and Persistent Vitellointestinal Duct
Beclards Hernia	Femoral Hernia Through Saphenous Opening
Bergers Hernia	Hernia in Pouch of Douglas
Bilocular femoral Hernia6	Femoral Hernia with two sacs
Bochdalek’s Hernia	Congenital Posterolateral Hernia of Diaphargm
Callison-Cloquet Hernia	Through Pectineus Muscle and its fascia
Cloquet’s Hernia	Hernia Through Pectineal aponeurosis
Cooper’s Hernia6	Femoral Hernia with two sacs
De Garengeots Hernia	Incarceration of appendix within Femoral Hernia
Dual Hernia1	Concurrent Ipsilateral Direct and indirect Inguinal Hernia
Femoral Hernia	Hernia medial to Femoral Vein in Femoral canal
Gibbon Hernia	Hernia with Hydrocele
Grubers Hernia	Internal Mesogastric Hernia
Grynfelt Hernia	Upper Lumbar triangle Hernia
Hernia En Glissae	Hernia with a part of the wall formed by the viscus
Hesselbach’s Hernia	Lateral to Femoral Artery
Holthouse’s Hernia	Inguinal Hernia That has turned outward into the groin
Kronlem Hernia	Inguinoproperitoneal Hernia
Larry’s Hernia4	Through Larry’s space in Diaphargm
Laugier’s Hernia	Through Lacunar Ligament
Little’s hernia3	Appendix in inguinal  Hernial Sac
Littre’s Hernia	Contains Meckel Diverticulum
Lumbar Hernia	Hernia in lumbar triangles of type Petit’s and Grynfelt
Maydl’s Hernia2	Two loops of bowel in Hernia sac with remaining part in abdomen
Mery’s Hernia7	Through the perineal floor
Mesocolic hernia	Transmesenteric Hernia
Morgagni Hernia4	Through Larry’s space in Diaphargm
Narath’s Hernia	Behind Femoral Artery in congenital dislocation of Hip
Obturator Hernia	Hernia through Obturator Canal
Perineal Hernia7	Through the perineal floor
Petit’s Hernia	Lower Lumbar Triangle Hernia
Phantom Hernia	Localised Muscle Bulge following Muscle Paralysis
Retrograde Hernia2	Two loops of bowel in Hernia sac with remaining part in abdomen
Richter’s Hernia	Part of circumference of bowel wall is entrapped
Rieux Hernia	Retrocaecal Hernia
Romberg Hernia1	Concurrent Ipsilateral Direct and indirect Inguinal Hernia
Saddle Hernia1	Concurrent Ipsilateral Direct and indirect Inguinal Hernia
Sciatic hernia	Hernia through greater or lesser sciatic foramen
Serofini’s Hernia	Behind Femoral Vessels
Sliding Hernia	Hernia with a part of the wall formed by the viscus
Spigelian Hernia	Hernia through Speligian Fascia
Teale’s Hernia5	In front of Femoral Vessels
Trietz Hernia	Paraduodenal Hernia
Velpeau Hernia5	In front of Femoral Vessels
W Hernia/Hernia in W2	Two loops of bowel in Hernia sac with remaining part in abdomen

The number in superscript suggest that the hernias with the same number are actually same with various names.

Sources

SRB’s Manual Of Surgery

https://medicallegends.blogspot.com/2015/08/named-hernias.html

http://lessons4medicos.blogspot.com/2009/07/different-eponymous-types-of-hernia.html

Internet

All Anthropometry Formulas and values in Paediatrics: Height, Weight, Head circumference

Normal Anthropometric values at birth 

Anthropometry formula for expected parameters in pediatrics

Normal Anthropometric Values at Birth

Parameter	Range	Normal for easy memory
Weight	2.5-3.5kg	3 kg
Length	45-55 cm	50cm
Head circumference	33-37cm	35cm

Calculate body surface area from the weight (kg)

Body Surface area = (4w+7)/(w+90) m²

Ideal weight gain

Age	Expected weight	Rate of weight gain  g/day
Up to 4 months	3-6kg	30g/day
4-8 months	6-8kg	20g/day
8-12 months	8-10 kg	15g/day

Age	Rate of weight gain  g/week
3 months	200 g/week
4 – 6 months	150 g/week
7 – 9 months	100 g/week
10 – 12 months	50 – 75 g/week
1 – 2 years	40 g/week
2 - puberty	30 g/week

All you need to remember for baby weight 

Age	Rate of weight gain
Up to 3 months	30  g/day
3 months to 1 year	400 g/month
3-7 years	2 kg/year
7 years to adolescence	3kg/year

The weight of any baby should multiply in the following rate ideally

Birth Weight (x)	Time	Examples (2.5kg )
2x (Doubles)	5 months	5kg
3x (Triples)	1 year	7.5kg
4x (Four Times)	2 years	10kg
5x (Five times)	3 years	12.5kg
6x (Six times)	5 years	15kg
7x (Seven times)	7 years	17.5kg
10x (Ten times)	10 years	25kg

Formula to calculate expected weight at certain age

Age	Weech Formula
3-12 months	(Age in months + 9) / 2
1-6 years	Age(years)x2 + 8
7-12 years	(Age in years X 7- 5)/2

Inability to gain adequate weight, may be undernutrition. Learn about marasmus and kwashiorkor 

Measurement and calculation of Height

Age	Length at birth
Birth	50cm
3 months	60cm
1 year	75cm
2 years	90cm
4-5 years	100cm
5 years to 10 years	5cm/years
Adolescence	8 cm/year for girls during 12-16 years 10cm/year for boys during 14-18 years

Expected length gain in pediatric

Weech Formula for expected height from 2 years to 12 years

Expected height = age in years x 2 + 77 cm

Rate of gain of length/ height

Age	Gain in length/height
Up to 3 months	3.5cm/month
6-9 months	1.5cm/month
9-12 months	1.3cm/month
2-5 years	6-8cm/year
5 years to 10 years	5cm/years
Adolescence	8 cm/year for girls during 12-16 years 10cm/year for boys during 14-18 years

Head Circumference

Birth	35 cm
3 Months	40 cm
1 years	45 cm
2 years	48cm
5 years	52cm

Rate of growth of Head circumference

Up to  3 months	2 cm/month
3 months – 1 year	2cm/ 3 months
1-3 years	1cm/ 6 month
3-5 year	1cm/ year

Dines formula to estimate HC at 1 years

(HC at birth(cm) + 9.5 ± 2.59)/2 

Learn about abnormality in Head circumference and their causes (Microcephaly, macrocephaly). 

Normal Values of Head circumference and Chest circumference

Chest Circumference 

HC > CC @ Birth by 3cm

HC = CC @ 9-12 months

HC< CC after 1 years

Mid Arm Circumference (MUAC)

Increase in first year       11cm - 16cm

1-5 years                         16cm - 17cm 

Sources: http://www.adsa.org.za/Portals/14/Documents/Clinical20Guideline20Anthropometry.pdf

Essential pediatrics OP Ghai 

Meherban singh Clinical Methods