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

Drug of Choice in Various Medical Conditions

Drug of Choice in Various Medical Conditions

>>Learn about drug of choice in various tropical and infectious causes.

Pathology	Drug of Choice	2nd Line therapy	Remarks
Acute Classical Migraine	Ergotamine tartarate
Acute Migraine attack	Sumitriptan
Anorexia nervosa	Fluoxetine
Bullemia Nervosa	Fluoxetine
Carotid Sinus Syndrome	Atropine / Ephidrine
Cluster Headache prophylaxis	Lithium
CML	Hydroxyurea
Heart Block	Atropine/ Isoproterenol
Hypertensive emergency	Sodium Nitroprusside
Idiopathic Pulmonary Fibrosis	Oral Corticosteriod		Aka Hamman Rich Syndrome
Idiopathic Thrombocytopenic Purpura	Oral Steriod (Prednisolone)
Kawasaki Disease	IVIG
Metabolic Acidosis in Cardiac arrest	Sodium Bicarbonate
Migraine Unresponsive to NSAID	Sumitriptan
Multiple Myeloma	Mephalan
Nephrogenic Diabetes Insipidus	Thiazides
Neurogenic Diabetes Insipidus	Desmopressin
Oral Antidiabetic in Renal Failure	Tolbutamide/ tolazamide
Phentahazine induced dystonia	Diphenhydramine
Pheochromocytoma	Phenoxybenzamine
Prolactinoma	Bromocriptine
PSVT	Adenosine
Shy Drager Syndrome	Fluhydrocortisone
Ulcerative colitis	Sulphasalazine + Corticosteriod

>>Learn about drug of choice in various tropical and infectious causes.

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