mhaiap final 18 virsionmahaiap.org/mahaiap.pdfmaharashtra state branch of india academy of...

2019Maha Academy of PediatricsMaharashtra State Branch of India Academy of Pediatrics

Society Reg. No. Maharashtra/529/2009/Nashik

Editors

Dr. Sadachar UjalambkarDr. Sonali Shirbhate

Secretariat

3rd floor‚ B wing, Rambaug Society‚ Gangapur Road‚Nashik – 422 005 Maharashtra, India

Website: www.mahaiap.org | E-mail:[email protected]

MayIssue : 1

www.mahaiap.org

MAHA-IAP 2019 - Office Bearers

Dr. Sanjay GhorpadePresident

Dr. Lalit Rawal

Immediate Past President

Dr. Laxman Kadam

Vice President

Dr. Sadachar Ujalambkar

Secretary General

Dr. Amol Pawar

Treasurer

Dr. Shripad Jahagirdar

Joint Secretary

Dr. Sagar V.

SonawaneImmediate Past Secretary

Executive Board Members CIAP

Dr. Ganesh Kulkarni Dr. Anand Deshpande Dr. Atul Kulkarni

Dr. Samir DalwaiDr. Suchit Tamboli

INDEX

Sr. No. Title Page No.

1. Glimpses of Mahapedicon 2018

2. President’s Message

3. Secretary’s Message

4. Editor’s Message

5. 1st EB Meeting of MahaIAP 2019 at Amaravati

6. What’s your HQ - Happiness Quotient? Writer - Dr. Shilpa Aroskar

7. Newborn Screening New Hope or Hype Writer - Dr. Naresh Tayade

8. Irritable Infant Writer - Dr. Sagar V. Sonawane

9. Communication, Smile & Medical Profession Writer - Dr. C. S. Dabhadkar

10. Article on Media Viewing & Internet Addiction Writer - Dr. Suchit Tamboli

11. Invitations from - The ELLORA SUMMIT - Mid term CME of Maha IAP,Aurangabad - 16th NCDP 2019 Pune - Mahaneocon, Nashikon 2019 - Respicon 2019 Pune - MAHAPEDICON 2019, AMRAVATI - PEDICON 2020, INDORE

12. संवेदनशीलता Writer - Dr. Pramod Jog

13. Activities of IAP Branch

14. Office Bearers List of all IAP Branches of Maharashtra State

President ’s Message

Jai Maharashtra , Jai IAP..

Hon. President

Dr Sanjay Ghorpade

MahaIAP 2019

Seasons greetings

In further activities I suggest BLS courses for doctors & community at large in each zone of

Maharashtra. CME for post graduate students at various medical colleges, carrying out central IAP

membership drive in full force so that our representation will get more prominent at central IAP.

Dear colleagues,

It’s been my great pleasure & fortune to upheld the presidents post of Maharashtra IAP this year for me. I

thank you from bottom of my heart for making 1st west zone Pedicon & Mahapedicon 2018 at

Mahabaleshwar a grand success by your active participation & great response. Many thanks to all those

who has contributed immensely in making this event a memorable one.

Many activities are there in my mind by MahaIAP to be carried out this year. I invite you all to first mid

term CME of this year at Aurangabad on 28th July 2019. We are planning to have 2nd mid term CME as

Monsoon CME at Raigardh also this year.

I am very much impressed by the efforts taken by my editorial team Dr Sonali Shirbhate & Dr Sadachar

Ujalambkar for the first issue of this years bulletin of Maha IAP .

I wish you all the very best & expect your active participation in all these Maha IAP activities .

I urge all branch office bearers to celebrate various days & weeks with full enthusiasm.

Secretary’s Message

Dr Sadachar Ujalambkar

Hon. Secretary General

MAHA IAP 2019-20

I appeal to all to register & attend ELLORA summit of Maha IAP on 28th July 2019 in large numbers

which is going to be a great academic feast for all.

I thank President Dr Sanjay Ghorpade sir & Dr Sonali Shirbhate madam for their cooperation &

support.

We have tried to incorporate maximum recent branch activities conducted this year all over

Maharashtra state. There are intimations & details of important conferences also. The soul of this

bulletin is very informative & interesting articles written by our own fellow colleagues. I request you all

to give your valuable feedbacks to us.

Seasons Greeting..!

We are very much glad to present first issue of MAHAIAP bulletin 2019.

I personally feel there is a lot of scope in improving doctor- patient dialogue. This will enlighten our

image in society at large. You will find opinions & thoughts regarding the same in this issue which will be

definitely useful in our daily clinical practice.

Dear colleagues,

Editor’s Message

Thanks to all branchoffice bearers of the state for their kind cooperation .

We especially thank Hon.President

First of all wishing you all A very happy monsoon & greetings...Dear All fellow IAPians...

Few words we want to share about this Bulletin....

It gives us immense pleasure as an editors to prepare this first issue of MahaIAP bulletin 2019...

This can be an academic or non - academic as both are equally important.We appeal to all fellow members to give their valuable feedbacks.

This bulletin is a platform for expressing the views & putting the facts of knowledge about the particular topic or thought process.

We are distributing this as soft copy to all members or it can be downloaded from the link given from the website www.mahaiap.org

Dr.Sanjay Ghorpade sir for their wholehearted support.

श�द�ची फुलं झाली आहेत आज येथे..

Jai Maharashtra IAP

Editors Dr Sadachar Ujalambkar [email protected] | 93705 76282

A big thank you to all of you...

Dr Sonali Shirbhate

आप�या ��मत हा�याची , �िणक आठवण झाली..

Jai Hind ...

�हणुन आ�ही ओंजळीभर फुलं, उधळली येथे....!!

[email protected] | 98230 77106

1st EB Meeting of MahaIAP 2019 at Amaravati

WHAT'S YOUR HQ-

Happiness Quotient?

As a student I was always very aspiring and focused like most of us are, so when I got

admission into a renowned medical college LTMMC Mumbai I felt elated. Then followed

the gruesome years of burning the midnight oil and toiling hard during residency years for

post graduation. I use to think that once I get the MD degree I will finally breathe a sigh of

relief and be happy. But I was mistaken! The real struggle began after that.... setting up a

new practice, managing financial loans, having a family and multitasking all definitely

took a toll. I got so weighed down by life's daily ratatouille that I was always stressed out

(PDA -Perpetually Dukhi Atma). I dreamt of a day when I would be the busiest consultant

in my area, earning in six figures, owning a big house, a car, taking vacations abroad, and

achieving name and fame .So I always "postponed " being happy in the bargain to fulfill

my future desires and dreams. While we all doctors strive towards perfection, to be the

best in our profession, and for women like me to also achieve a good work home balance,

life is like running on a treadmill. As the years pass by, we all are able to avail the

materialistic luxuries of life like I did and a fair status in the society. But the million-dollar

question is how much is "ENOUGH".

How do I measure my happiness? Is there a universal standard to gauge happiness like

a "blissometer" and a chart to monitor the percentiles like we have pediatric growth

charts? I pondered and goggled my brain to search the answer from within my soul. The

source of the word Happiness is the Icelandic word Happ, which means, "luck" or "by

chance". I certainly did not want to leave the experience of happiness to chance, so I took

it up as a mission to find out how to be happy.

I was taking some time off from my busy OPD to help my younger one finish her school

worksheets. They were asked to write few lines on "What would I want to grow up to be?

"I was assuming she would say either "A doctor"(genetic trait) or any other profession. To

my utter amazement, she said very innocently " I want to grow up to be HAPPY”!! I was

benumbed and flabbergasted .An eight years old child opened my eyes and made me

contemplate - Was I happy and how important happiness was to me?? This serendipity

woke me up from my groggy haze and deep anesthesia and I began to see the light.

Dr. Shilpa AroskarMD, DNB, DCH

Navi Mumbai

[email protected]

4) More wealth and more success necessarily need not make us happier- While having

luxuries in life certainly makes it easy and comfortable we need to use the word

"enough”. We no longer accumulate to live but live to accumulate. If only money was a

measure of happiness all the richest people in the world would never be sad or

despondent. In Fact a study done had revealed that higher incidences of suicides,

3) Mapping your Life- Think of all the things you always wanted to do but refrained so due

to busy work schedules on weekdays and attending conferences on weekends either as

a faculty or as a delegate. Set apart and schedule some ME time of at least one-hour

daily or over weekends. I started pursuing my hobby of writing, which is akin to

meditation for me, a stress buster. In Fact I got lucky enough to find a publisher to publish

my script into a book. Be it singing, music, dancing, sports, cooking or even spending

time with your loved ones don't postpone for later The time is NOW, do it right away and

see how happy you feel and how happy you make others to.

1) Practicing Gratitude and counting the positives in life - Get up each day morning and

make a list of things in your mind while doing the morning chores for all the things that we

are thankful to God for, it could be as small as taking a morning walk, enjoying a masala

chai in the balcony or seeing the children off to school .The more I counted my blessings

the richer I felt.

2) Enjoy your work each day and try to get 'MEANINGFUL PLEASURE " from it. Most of

the days we brood about our work, our boss, our colleagues and at times the whole

system. The result is feeling depressed. So change the frequency of your thoughts like

you change the radio station, don't work like a robot but do it with gusto and see it as your

calling. The moment I did that I could overlook my staffs micro mistakes or getting irked

on nagging patients demanding 'quick fix ' for ailments.

While buying a big car, moving into a new house, being invited as an international faculty,

seeing your name in the newspaper and winning accolades and many more of reaching

targets and attaining goals certainly gives us "instant " Happiness or pleasure, but how

long does this lasts?? According to this approach Happiness is an end process, a finite

point, a dead end once we reach our destination or attain our goal, we mistake the relief

that we feel as happiness. !! So then if this is giving me only ephemeral or transient

happiness then how do I stay permanently happy? It dawned upon me that happiness is

not about making it to the peak of the mountain nor is it climbing aimlessly around the

mountain but it is the experience of climbing towards the peak.

So I took it up as a challenge to keep myself happier and how? Here is my magical

prescription of Being Happier that I share with you all

8) Joy of Giving- I vividly remember the surge of joy I experienced when I bought my

mother a watch and father a shirt from my first stipend after MBBS. Think back of a time

when you behaved benevolently towards a patient by not charging, or sharing an idea

with a friend, giving flowers to your loved ones or donating for a cause you believe in. I am

sure you must have felt a deep sense of satisfaction and bliss in doing so.

alcohol and drug abuse, cardiac diseases and psychological disorders were seen in the

more affluent class what is called "AFFLUENZA”.

7) Don't Strive For Perfection- As a doctor I always wanted the best for my patients. So

when I was unable to cure a patient or save a life, I use to be highly-strung, unable to

accept failures. We all get this feeling often in our profession. However I gradually learnt

to accept that I am not God, I have my flaws and weaknesses, but my job is to do my best,

take help from colleagues when needed and rest we should leave it to the Almighty. We

need not strive to be a perfect doctor, spouse, father, mother or a son.

6) Building up good relationships - After a Long day at work when I come home it's the

hugs from my children and their non stop chatter that makes me forget all the day's

stress. And I beat my blues by just talking to a friend or spending time with them and turn

the blues into blush over a dose of laughter. Having people to share our pains and

feelings and to care for them gives us the supreme happiness. Never let your pesky ego

come in the way of relationships. Love unconditionally, never leave any words unsaid,

and spend time with people who bring out your best, pick up the phone to talk to a long

lost friend or take your old parents out for a Sunday brunch. The smile on their faces and

the twinkle in the eyes shall fill up your hearts with everlasting joy.

5) This too shall pass- while it is the law of life that the seasons keep changing; we

experience the high and the ebb of life's journey. However we need to learn to accept

these without complaining "Why Me”? We need to stay resilient and have faith in God in

times of adversities till we emerge triumphant in the end. Honestly, I learnt these

important life lessons from my pediatric patients. While battling many critical life-

threatening illnesses in the ICU, many of them paved a path to miraculous recovery,

which I always believe was science along with the power of hope and faith. Also when I

introspect and look back at the trials and tribulations of my life, I now realize that they

always taught me something in the end. So while staying positive we can continue to feel

the bliss even in times of negativities and despair and hope that this too shall pass. After

all -Que sera sera.

9) Hurry and worry - We get too busy trying to squeeze more activities in less time,

consequently fail to savor and enjoy our tasks. We must simplify our lives to reduce the

self-created complexities of life. You cannot gulp wine fast you have to sip slowly to savor

it similarly if you want to enjoy life you have to cease to be a rat racer and get out of the

pressure cooker. Also prioritize and choose smartly your activities, Learn to say NO

when you don't want to attend a particular event or do an activity.

10) Here and Now- We often imagine that reaching some destination in "future" will make

us happy and at peace however after reaching there we experience a period of

"happiness drought”. Or we brood over our past unhappy events and constantly live with

fears and insecurities of future. The time is NOW, seize the moment, let go of the past and

stop controlling the future.

I have replenished my Emotional bank with HQ? Have you? What's your quotient then?

Fill it a.s.a.p. Before you are bankrupt of it!

I won't say that I am perpetually in a state of bliss like a monk; in fact I have too many

highs and lows. Nor these principles are a panacea to bliss. However we could

"CHOOSE " to be happier. We can inject ourselves with Happiness "Boosters" when the

going gets tough or boring by just being with friends or family or practicing a favorite

hobby.

Lastly there is nothing like “settling down” in life. I find the whole concept misleading. We

think we will settle down after finishing studies (seriously), maybe after marriage (nope),

after having kids, after being successful, then after kids are grown up but it never

happens. Why settle?? Life is not meant to settle down, but to explore, to wander, to lose,

to love, to learn, to unlearn, to fail, to rebel, and to live. Even our ashes don't settle in the

end but fly away in all directions !

NEWBORN SCREENING

NEW HOPE OR HYPE

Which disease it screen?

It is procedure by which the healthy newborn is tested for some diseases in

asymptomatic state.

Core disease: Disease with high incidence rate and for which treatment is easily

available and affordable. eg. Hypothyroidism, Congenial adrenal hyperplasia (CAH),

The New Born Screening began in 1963 in USA with the pioneering work of Dr. Robert

Guthrie and now completed its 54 years. In India alone about 25 million baby born every

year out of which 0.1 % ie. 2. 5 lakhs may have some or other form of metabolic

diseases. The Oxford Dictionary of Public Health defines screening as “the

identification of a previously unrecognized disease or disease precursor, using

procedures or tests that can be conducted rapidly and economically on large numbers

of people with the aim of sorting them into those who may have the condition(s)…and

those who are free from evidence of the condition(s).”

It is done generally after day 3 of life.(can be done earlier in some cases)

When it is done?

In India Chandigarh and Goa are states where newborn screening was started at

government level but now stoped. The American Academy of Pediatrics and ACMG

support the mandatory offering of newborn screening for all children. After education

and counseling about the substantial benefits of newborn screening, its remote risks,

and the next steps in the event of a positive screening result, parents should have the

option of refusing the procedure, and an informed refusal should be respected. But

there are lots of ifs and buts in doctors mind about this procedure this article tries to

answer this queries so that proper decision became easy.

What is newborn screening?

This list is increasing day by day. But it consist of two groups :

Dr. Naresh Tayade

MBBS, DCH, DNB

SIAMG Fellowship in clinical genetics

Amravati | [email protected]

Screening test had high negative predictive value i.e. chance of disease is very less if

child had negative screening test. It is done in asymptomatic child. Diagnostic test is

done in symptomatic child or child with positive screening test to confirm or refute the

diagnosis.

Four drops of blood is collected by heel prick method on filter paper and sent for

evaluation. For aminoaciduria and FAOD urine on filter paper can also be used.

This can be easily explained by considering example of congenital hypothyroidism:

incidence of congenital hypothyroidism is 1: 500-3400 so if we see 50 child daily then

there must be one case of hypothyroidism diagnosed in 1 month but if we diagnose this

so frequently? The symptom and sign of hypothyroidism are fully developed over the

period and as they are not life threatening came to medical attention very late. In

developed countries also 1/3 patient diagnosed at > 5year with mean age of diagnosis

was 10mo to 5yr. Till that age child may be severely mentally retarded or short stature.

While if this child diagnosed in NBS programme and treated properly have normal

mental and physical development. Similarly child with salt losing variety of congenital

adrenal hyperplasia may present in shock and died undiagnosed more so with male

child due to no genital abnormality while girl with virilising form may present in

adolescence with hirsutism or delayed puberty causing severe psychological issue

which can be easily prevented with NBS.

If any child with previous history of early neonatal death or neuroregression. Child

G6PD Deficiency, Sickle cell, hearing evaluation etc

In India which diseases should be included in core panel?

Expanded Screening: the other metabolic diseases which individual incidence may be

low but collectively they are major health problem but treatment some time may be

difficult and not easily available. Eg. Aminoaciduria, fatty acid oxidation defect.(FAOD)

Positive result increase chances of disease in child but it had to be confirmed with

confirmatory test.

What is high risk screening?

What is difference between screening and diagnostic test?

In India Congenital Hypothyroidism (Incidence 1: 500-3400), CAH (1:6813),

G6PD(1:192), Sickle cell along with hearing evaluation should be included in core

panel.

Why should we test the child who doesn't have any symptom?

Is positive result means child had disease?

How this screening is done?

In high risk screening if previous child is confirmed diagnosis we should go for

diagnostic test for it. If no confirm diagnosis is available or history not pointing toward

specific disease and present baby is normal then do NBS. If baby presented with clinical

feature described, then we should try to have clinical diagnostic possibility before going

to test. In this case if NBS negative we may required further testing if diagnostic

possibility remains very high. Eg. In child with nonimmune hydrops fetalis possibility of

some storage rather than FAOD or Aminoaciduria so we required different test and not

NBS.

No, that only means if the possibility of screen disease is very less in that baby.

This is common exemption given but if we talk and explain them they may be ready. Like

ANC USG initially not done by relative but now if not done relative may asked for it.

If we compared cost with other thing and benefit it got cost is less. For individual test in

core panel 300rs each and for total 56 it is 5000rs.

Like HIV pre and post counseling is very important in telling the report to relative and

should be done by person with proper knowledge about this disease.

So NBS is great advantage in our field to save our little bay from consequence of

forthcoming danger in timely manner.

Relative are not ready?

In this cases if we done NBS it is known as high risk screening.

Is this test negative in healthy newborn that means child don't have any metabolic

disorder?

admitted in NICU with poor feeding, lethargy, coma, recurrent hypoglycemia, sudden

deterioration after period of normalcy, shock, resistant seizure, severe metabolic

acidosis, hyperammonia,etc.

Cost is high?

What precaution we should take while telling the report?

What points we should kept in mind while doing high risk screening?

Is a challenge to caregiver and paediatrician. It can be defined as a patient younger than

1 year of age who according to the caregiver, cries excessively or is excessively fussy.

Causes: Less than 5-10 % of infants who present for medical care due to excessive

crying will have a serious underlying aetiology (Table: 1).

Diagnostic approach:

Although most irritable infants do not have significant underlying pathologic processes,

medical providers should recognize the profound anxiety and stress that infant crying

may place on families. Excessive crying generally resolves with time, the family's

beliefs about the cause of the crying can have a lasting effect on the way they interact

with the child and their beliefs about the infant's health. Caregivers who perceived their

infant's crying as excessive or inconsolable described higher rates of depression,

strained family relationship, and guilt about their inability to calm the infant. It may even

trigger the thoughts of harming the child. Infants with early cry-fuss problems in

combination with family dysfunction are at higher risk for behavioural problems.

A thorough medical evaluation is needed to identify the minority of infants with treatable

issues, and in healthy infants a thorough evaluation may reassure caregivers. Table 2

lists elements of history and physical examination suggestive of emergent and common

diagnoses that may present with a chief complaint of crying. Infants with sudden

increase in frequency and duration of inconsolable crying compared to normal are more

likely to have underlying medical condition. Clinicians should also ask caregivers why

they think the infant is crying in order to specifically address any fears about the infant's

health.

Irritable Infant

Dr. Sagar V SonawaneMBBS, DCH, DNB

Nashik

[email protected]

What should be done by caregivers to reduce the amount of crying over a long term?

Addressing caregivers' response to crying:

Initial approach to the irritable infant (Flow chart 1):

When the history and physical examination do not suggest a diagnosis, additional

laboratory or radiographic evaluation may be needed. In particular, if infant is ill-

appearing, has evidence of poor growth or developmental delay, or is persistently

inconsolable beyond the initial assessment, laboratory and radiographic studies should

be done (Table: 1). Patient may need to be monitored in the hospital until a diagnosis

can be established.

The distress, frustration, and anxiety that persistent or inconsolable crying may cause

caregivers should be recognized and acknowledged with empathy, regardless of the

cause. Normal infant crying progressively increases after 2 weeks and peaks in the 2nd

month of life, then gradually decreases by 4th or 5th month. It generally peaks in the late

afternoon and evening within the 1st 6 months of life. At times it may be unrelated to the

needs of infant. Therefore, even in healthy infants some episodes of fussiness will not

be soothed with typical caregiver attempts to soothe, such as feeding, cuddling,

carrying, and diapering, and may occur for up to 4-5 hours per day.

Physical contact, feeding on demand, Rooming-in in first month of life helps to reduce

the amount of crying over a long term. A consistent daily routine may assist infant's

ability to self-regulate, resulting in decrease duration of crying bouts. Some calming

evidence-based techniques include swaddling young infants and decreasing

stimulation. Other measures parents can also try to soothe excessively crying baby by

giving pacifier, rocking the infant in a calm environment, or providing some background

In the consolable infant without history or physical examination findings suggestive of a

serious condition, nonemergent causes are more likely. The most likely diagnosis in

infants younger than four months of age is above average crying in a normal infant. If the

definitive diagnosis is not established in consolable infant, follow up evaluation within 24

hours is needed to ensure that more serious illness was not missed and to address any

additional concerns or questions about crying.

Treatment with anticholinergic drugs (dicyclomine hydrochloride, dicycloverine, and

cimetropium bromide) was effective, but is associated with unacceptable side effects.

Treatments that are not effective are: simethicone, diamethicone, fibre-enriched

formula, chiropractic treatment, or the introduction of lactase enzyme into the infant's

milk.

noise or vibration. Promptly initiating soothing measures before the crying becomes

inconsolable may help to decrease the duration of crying. Caregiver should be

reassured by information that bouts of fussing do not necessarily indicate illness or pain,

but may simply reflect the infant's inability to regulate the crying once it has started and

that it is transient and not necessarily predictive of ongoing behaviour problems in

childhood. In a prospective, community-based study of outcomes in infants with sleep

and cry-fuss problems, only 5 % of mothers reported persistent problems at age 2.

Several reports have been published of hospitalization or death in infants treated for

excessive crying with sedating medications such as dextromethorphan and

diphenhydramine, dimenhydrinate, and opiates. Clinicians should counsel parents

about the dangers of using these medications in young infants.

Some remedies like Fennel extracts, oral sucrose, and herbal tea may show promise as

a way to decrease crying, but additional studies are indicated for effectiveness and

possible negative effects of these treatments.

Table-1 Differential diagnosis in the irritable infant and Initial Ancillary Testing or

Referrals to Consider for Specific Diagnosis

Emergent / Urgent dignoses Non emergent / Urgent

dignoses

Eyes, Ears, Nose, Throat

Choanal atresia

Corneal abrasion

Foreign body

Glaucoma

Otitis media

Otitis externa

Teething

Fluorescein stain

Opthalmology consult

Radiographs and/orENT

consult

Respiratory

Airway obstruction (croup,

Foreign body )

LRTI (Pneumonia, Bronchiolitis)

URTI

Chest radiography, pulse

oximetry,

nasopharyngeal viral

tesing

Plus bronchoscopy

Cardiovascular

Congestive heart failure

Supraventriculer Tachycardia

Anomalous coronary artery

Myocarditis

Kawasaki Disease

Chest radiography, pulse

oximetry,

ECG, echo cardiography,

CBC, CMP, BNP

Cardiology consult

Gastrointestinal System

Incarcerated Hernia

GI Obstruction

(Intussusception,

Volvulus,Pyloric stenosis

Constipation

Uncomplicated

gastroenteritis

Anal fissure

USG with Doppler

CBC, CMP, amylase,

lipase, abdominal &

pelvic radiography &/or

CT, air contrast emema

Musculoskeletal System

Osteomyelitis

Septic Arthritis

Fractures

Minor soft tissue injury

Discitis

CBC, ESR, CRP, blood

culture, radiography,

MRI, orthopedic consult

Skin

Cellulitis

Tourniquet Syndrome (Digit,

genitalia)

Impetigo

Dermatitis

Insect bites

Minor injury

CBC, wound culture

Centre Nervous System

Encephalitis

Meningitis

Increased ICT (Trauma,

hydrocephalus, intracranial

hemorrhage)

Intracranial mass

Lumbar puncture, head

CT or MRI, CBC, blood

culture

Miscellaneous

Drug ingestion

Neonatal abstinence syndrome

IEM (Inborn errors of

metabolism)

Sepsis

Sickle cell crisis

Physical abuse

Vaccine reaction

Poor caregiver-infant

interaction

Normal crying

Comprehensive urin drug

screen

Urin or meconiun drug

screen

IEM screening

Sepsis screen

CBC, reticulocyte cout,

CXR, pulse oximetry

Table 2: Clinical presentation of selected diagnosis in infant presenting with crying

Review of system Possible physical exam

findings

Diagnosis to consider

Genitourinary system

testicular swelling

previous urinary tract

infection

Testicular swelling,

tenderness

suprapubic tenderness

nonspecific exam

testicular torsion

urinary tract infection

Musculoskeletal

system

decreased movement

of an extremity

increased crying with

movement

swelling,tenderness,w

armth,

Erythema, pain or

crepitus with palpation

or movement

Nonspecific exam

fractures

soft tissue injury

osteomylitis

septic arthritis

Skin

rash

purulent discharge

itching

swollen appendage

swelling, tenderness,

warmth,

Erythema,rash

well demarcated line

separating normal

tissue from distal

dusky,

oedematous,appendag

Infection

dermatitis

insect bite

tourniquet syndrome

No history or history of

prior suspicious injury

prior history of

symptoms of increased

intracranial pressure

nonspecific exam

retinal haemorrhage

with or without other

injury

abusive or non-abusive

head trauma

Eyes, ear, nose, throat

pain or irritation of eye

chronic or intermittent

tearing

difficulty breathing or

cyanosis during feeds

symptoms improve

with crying

otorrhea

fever

ear tugging

photophobia

tearing

foreign body seen on

lid inversion

corneal enlargement

Ocular enlargement

Optic nerve cupping

photophobia

inability to pass a

nasogastric tube

deceased air

movement through

nares

Bulging or immobile

tympanic membranes

abnormal color or

perforated tympanic

membrane

foreign body

Corneal abrasion

Glaucoma

Choanal atresia

Otitis media

Otitis externa

Respiratory

trouble

breathing,cough,

congestion

abnormal breath

sound

respiratory distress

airway obstruction

pneumonia,

bronchiolitis

Cardiovascular

tachypnoea and

diaphoresis with feeds

trouble breathing

easy fatigability

pallor,cyanosis

tachycardia

respiratory distress

poor perfusion

abnormal breath

sounds

abnormal heart sounds

hepatomegaly

cardiomegaly

congestive heart

failure

supraventricular

tachycardia

anomalous coronary

artery

myocarditis

Gastrointestinal

system

Constipation [hard

stools,<2 per wk.]

Nonspecific exam

Stool mass in lower

quadrant

Anal fissure

Constipation

Delayed passage of

meconium, poor

abdominal distension

tight anal canal with

Hirschsprung disease

Miscellaneous

medication

administration

illicit drug used by

caregiver

nonspecific exam

altered mental status

tachycardia,

respiratory or cardiac

compromise , seizures

Drug ingestion

Maternal drug used in

new born

poor feeding,

vomiting, sneezing,

hiccups, poor sleep

,tremors

nonspecific exam Neonatal abstinence

syndrome

vomiting

poor growth

developmental delay

or regression

seizures

dehydration and

shock, organomegaly,

abnormal neurological

exam, jaundice

dysmorphic features,

abnormal odour,

Tachypnoea

inborn error of

metabolism

Lethargy, with or

without fever,

seizures

ill-appearing

cardiorespiratory

compromise

sepsis

Table 2: Clinical presentation of selected diagnosis in infant presenting with crying

Flow chart 1: Initial approach to the irritable infant

Supportive care as required

(airway,breathing,circulation)

Infant with irritability

Careful history and physical exam(consider emergentdignoses first )(see table 26-2)

Does history or physical exam suggest dignoses?YES NO

-ill appreaing

-inconolable beyond intial assessment

-history of unexplained poor grwth,developmental delay

YES

NO

For all dignoses at initial presentation or at follow up- evaluate how caregiver are coping with crying- address any fear about possible cause of crying- provide education on infant crying and soothing- consider referral to support services and family therapy or infant mental health expert in high-risk families

Schedule follow up

Consider ancillary testing foremergent diagnoses(see table 26-1)

Consider non emergentdignoses(see table 26-3)

Consider ancillary testing ifappropriate (see table 26-3)

(Statutory warning : This article is not for pediatricians who take history, examine it, then

investigate and treat more than 300 patients per day !)

It is a common misbelief that communication is proper explanation by proper words. Is it

really so? NO. Communication includes speaking as well as listening too (expressive and

receptive). Not only this, the body language matters a lot too. Further, it is said an ideal

On a more serious note, smiling is a part of communication. Communication is an integral

part of any profession. Success or failure depends on one's communication skills. This is

more important, especially in the medical profession. We constantly deal with major or

minor health problems. Some problems are serious, some are not, some are life-

threatening and some are not. No matter the situation, proper communication with proper

people with well-calculated words is always awarded with an increase in the number of

patients and avoidance of litigations, adverse media publicity, among other things.

It is said that if communication is inappropriate and incomplete, if you don't answer all

queries of a patient's relatives, it leads to anxiety, anxiety leads to irritation, irritation leads

to anger and then something adverse may happen. This may end in litigations, adverse

publicity by media and violence in some cases. There might not be any direct financial loss

but the loss of peace of mind, decreased number of patients, and popularity.

I heard in one of our conferences that it is the seriousness on a doctor's face that reflects

his intelligence. Hence, I concluded that pediatricians with piles 'look' more intelligent than

pediatricians with smiles!

Smile is the greatest gift God has given to human beings, especially to doctors (except

idiopathic and idiotic smiles).

Communication, Smile &

Medical Profession

Dr. C. S. DabhadkarMD, DCH, PGD-DN, FIAP

Raigadh

[email protected]

Benefits to patients/parents:

Whether it is Duchenne's smile or non-Duchenne's smile, it gives multiple benefits to the

smiler too. It improves their own state of happiness, has a positive effect on the willingness

to help others, happy people live longer, enjoy better health, are protected against

coronary heart disease and many more.

Smile leads to a feeling of wellbeing in patients, whether or not they return the smile.

Further, it helps in developing a proper rapport with patient/parents, increased confidence,

and alleviates some emotional burden.

Dr. Guillaume Duchenne, a French scientist pointed out that there are two major muscles

involved in smiling- Zygomatic major (ZM) and Orbicularis oculi (OO) (remember the days

of your Anatomy classes!). ZM will work only as per your will while OO will work only when

you put sweet emotions of the soul (true smile). This true smile is called Duchenne smile

and smile without OO is called non-Duchenne smile.

Interestingly, benefits of smiling were studied in waitresses and proved that smile helped to

Benefits to the smiler

Benefits to team

I came across a very good article sent by one of my friends titled 'Physician's smile' by

Andrew James. He says, “For millions, the smile has been recognized as a powerful tool of

communication device offering benefits to both, givers and receivers. True smile is a sign

of compassion, empathy and friendliness. Smiling can help not only doctors but also their

patients in developing a relationship based on trust.

communication is only 30 % speaking but 70% listening. Unfortunately, we don't have time

to listen and we talk about everything, do not listen to the queries of patients' parents and

that is where the problem starts.

Key references

profession too (Hoping to see some research on how smiling affects the doctor's fees) .

The culture of smiling may encourage effective team working...

So friends, add a smile to your prescription. But take care that it is not idiotic (!), idiopathic

and should be used at the appropriate time in the appropriate situation.

1) What's in a smile? A review of the benefits of the clinician's smile Andrew James

Beamish, Jessica Jane Foster, Harry Ed

2) Duchenne dB. The mechanism of human facial expression or an Electro-Physiological

analysis of the expression of the emotions (A. Cuthbertson, trans). New York:

3) Diener E, Chan MY. Happy people live longer: subjective well-being contributes to

health and longevity. Appl Psychol Health Well Being 2011;3:1–43.

What are signs of multimedia addiction?

Using multimedia as a sedative (2) Indiscriminate viewing (3) Loss of control while

viewing (4) Feeling angry with one self for watching too much (5) inability to stop

watching. (6) Feeling miserable when kept away from watching

What is multimedia tasking station?

Obesity, smoking, drinking, sexual risk taking and violence.

Not more than 2 hours.

Children's simultaneous use of different media or media multitasking is very common.

With television in the background, child uses computer or cell phone for instant

messages. Computer is "Media multi tasking station".

True

Media violence is a risk factor for aggressive behavior but is not related to crime. T/F

How much time a child should spend on all multimedia?

What are negative outcome of advertisement?

Parent child conflict, cynicism, obesity and materialistic attitudes.

What are five critical types of adolescent health risk behavior?

Multimedia

Viewing: FAQ’s

Dr. Suchit Tamboli

MBBS, MD Pediatrics Ph.D. Developmental Pediatrics, M.U.H.S.

Ahmednagar

[email protected]

What are symptoms of Internet Addiction?

Prefer to stay online longer than intended, 2) Neglects household chores to spend more

time online, 3) Prefers media indulgence rather than social interactions with peers, 4)

Prefers to make friends online than in real life,

Poor school grades due to the time and distraction of online activities,

Keeps checking social networking sites/e-mail/chat forums, 7) Develops anxiety if the

internet connection fail

What are important definitions of Internet Addiction?

Internet Addiction or Compulsion: When computer use is repetitive and constant, and the

users are unable to resist strong urges to use the computer

Cyber-relationship Addiction: When a person shows over-involvement in online

relationships and reflects a fast-paced generation's idea of equally fast and 'easy'

relationships.

Phantom Vibration: perception of vibration from a cell phone even when it is not vibrating.

What are the key areas in Psychological Management of Internet Addiction?

1) Encouraging interests/social activities, 2) monitoring computers use and setting clear

limits, 3) recognizing underlying problems that increase the intensity of addiction, 4)

Building coping skills, 5) strengthening exiting support systems

What are guidelines for parents about viewing multimedia?

Mobile Phone Compulsion: When a person compulsively uses mobile phones to call

people excessively and unnecessarily.

Cyber-sexual Addiction: Compulsive use of websites for cybersex and pornography

Time allotted should not be more than 2 hrs for all media. 2) Content of media must be

observed by parents. 3) Media should be used as third parent and not servant. 4)

Alternatives to the media like ground play, creative activities must be given by the parents.

Mahapedicon 2019 Invitation

Dr. Pramod JogMD Pediatrics

Past President of IAPPune

[email protected]

संवेदनशीलता

" अरे िनिखल, बघतरी थोडा वेळ - िकती छान िसनेमा आहे '�यामची आई'. एरवी तासंतास बघतो टी. �ही . आिण

आज काय झालं ? बघ तरी �या �यामचं काम िकती मनाला िभडतंय ! "

मुल��या संवेदन�ची जोपासना कर�याची मोठी जबाबदारी आज पालक�वर आहे. सुख , संप�ी , ऐशाराम

ु ूय�ची वाढ�या वयाबरोबर सवय जडते . उपेि�त , वंिचत , अपंग�ब�ल एक �कारचा बोथटपणा हळहळ यायला

लहानपणापासून य�ना आपण फुलासारखं वाढवतो . ' Good Boy, Good Girl ' �हणून �य��या कलाकलाने घेत

��येक गो�ट करतो. भरपूर खाऊ , खेळणी , टी. �ही. वर�या Animation world मध�या Characters �या

लहान वयात भावन�चा िवकास होणं (Emotional development) जसं मह�वाचं असतं तसं भावन�चं

शेजार�या घरातून सहजच कानावर वरील संवाद पडला. पाठोपाठ घराबाहेर पडणारे िनिखल, �याचे िम� व

�य��या मागे डो�याला �माल लावत बडबड करणा�या - मािणकताई असे ि��य िदसले.

मा�या मनात िवचार आला , की खरंच असं झालंय का. आजची िपढी खरंच अशी संवेदनाशू�य झालीय का ?

घरातील सव�जण एक� असताना , िवशेषतः सं�याकाळ�या वेळी एक� जेवताना पालक�नी अनौपचािरकपणे

काही गॊ�टी बोला�यात.

भावभावनात मा� हे समरस होतात आिण वष�तून के�हातरी येणा�या िविवध 'Days' ना फ�त य�ची

ूसंवेदनशीलता उचंबळन येते नी साजरे होतात - 'Father's Day', 'Mother's Day'.

एक� कुटंुब, नातेसंबंध , समाज , �दय�पश� सािह�य याब�ल�या जािणवा बोथट होत चाल�या आहेत की काय

अशी शंकेची पाल मनात चूकचकते.

"ए आई , उगाचच से�टी होऊ नकोस आिण मलापण नको बनवूस. तूच बघ तुझा लाडका िसनेमा. मला नाही

आवडत तो िसनेमा."

�थैय�ही मह�वाचं असतं. अपयश / पराभाव झाला, िनराशा पदरी आली , िदरंगाई झाली तर य�ना सामोरं

जा�याची मानिसक ताकद बु��य�क दश�िवते. रडणं ही झाली संवेदनशील मनाची भावना. पण पराभवातसु�ा

न रडता ��थर राहणं हे भाविनक बु��य�क च�गला अस�यास घोतक आहे.

लागतो. वाढ�या वयातील मुले या सग�याचा नकळत अनुभव घेत असतात. पालक��या मनातील कणव मुल�ना

िदसली तर ' जाग�क पालक�वा�या ' कसोटीला पालक उतरले यात शंका नाही.

िक�येक बुि�मान मुल�चा बु��य�क च�गला पण भावन�क मा� कमी असं िच� िदसतं. '�यामची आई ' वाचलं तरी

िन�वकार, समोर अपघात घडला तरी िन�वकार, काही िवशेष घडलं तरी िन�वकार, समोर अपघात घडला तरी

िन�वकार, काही िवशेष घडलं तरी िन�वकार अशी जािणवा बोथट झालेली मुलं िदसलं की मन अ�व�थ होतं. हीच

मुलं मोठेपणी संवेदनशू�य - डॉ�टर , वकील , िश�क , प�कार , शेजार�या घरी काय चाललंय याची दखलही न

घेणारा सामा�य माणूस तयार होतील अशी भीती वाटते ! फार काय तर अशी दोन मनं एक� आली तर िनम�ण

होईल संवेदनशू�य सहजीवन !

�या गो�टी मुल��या अंतःकरणाला िभड�या पािहजेत अशा गो�टी मुल��या मनः च�ूंसमोर पालक�नी उ�या

के�या पािहजेत.

क�पून ल� देणे (Empathy) यामुळे वैय��तत संबंध सुधारतात. ��णाला डॉ�टर जवळचा वाटू लागतो.

दवाखा�यात मुलाला घेऊन आले�या माते�या ग�यातील म�गळसू�ात सोने नसेल तर मी �या मातेकडून

तपासणी फी घेत नाही . फी मािगत�यावर एखा�ा ��णाला फी परवडत नसेल तर �याचे डोळे पाणवतात !

��णालयात भरती झा�यावर बील भर�यासाठी ��ण ग�यातील दािगने िवकतात, भ�डीकुंडी िवकतात,

सायकलसारखे वाहन असेल तर ते िवकतात. �ा सग�या गो�टी संवेदनशील मनाला यातना देतात.

एखा�ा ��णाला औषध आण�यासाठी आ�ही ि��पशन देतो ते�हा हे ि��पशन िशरसावं� मानून

पदरमोड करत पालक औषध आण�यासाठी दसुरी दोन मुलं पुढचा एक मिहना अध�पोटी राहतात , ही जाणीव

िकती डॉ�टर�ना असते ? वष�चे ३६५ िदवस ही संवेदनशीलता जपायची असते.

ही िटपलेली िनरी�णे मुल�पय�त पोहोचवावी लागतात.

दसु�याचे ऐकून घेणे , समोरचा बोलत�ना ल� देणे, ही एक मह�वाची गो�ट आहे. दसु�या�या जागी �वतःला

िक�येक डॉ�टर ��णाशी बोलत�ना मधेच फोन घेतात, ��ण�ची त�ारी ल�पूव�क ऐकत नाहीत. जो उ�म ल�

देतो, तोच आपले �हणणे दसु�याला च�ग�या �कारे समजावून देऊ शकतो.

घरातही मुले उ�साहाने सारखी काही गो�ट स�गू इ��छतात. अशावेळी पालक�नी �य�चे बोलणे नीट ल� देऊन

ऐकावे.

िनबंध�मधून ' आ�मवृ� ' िलिहताना दसु�या�या मनात मुलं क�पनेनं �वेश करीत असतात. मनात�या भावना,

िवचार आ�मवृ�ातून बोलनू दाखवतात. आयु�यभर उपेि�त रािहलेला वग�तला बाक, फळा, शाळेची घंटा

यासार�या िनज�व व�तूं�या मनातलेही मुले स�गत असतात. मुल��या रोज�या पिरचयाची िवषय�मधून मुल�ची

संवेदनशीलता वाढवणे िश�क�ना श�य आहे.

छो�ा पड�ावरची काटू��स �हणजे मुल�चा जीव की �ाण. वा�तिवक काटू��स ही मुल��या मनोरंजनासाठी

उदा. हॉ��पटलमधील आजारी �य�ती, र��यावरचा अपघात ( अशावेळी काय करणं अपेि�त आहे ), शाळेचा

शेवटचा िदवस , बाबा परदेशी जात�ना िवमानतळावर मन�त आलेले िवचार , रडू आलं ती एखादी आठवण,

लॉटरी

आनंद , दःुख , भीती , �ोध , �चता , असूया , आदर , �ेम अशा वेगवेग�या भावना मनात येत असतात.

भावन��या वेगवेग�या छटा मुल�ना श�दब� करता या�यात यासाठी मुल�नी काही िवषय िलहायला �कवा

बोलायला �ावेत.

डो�यासमोर िदसणा�या घटना, �संग�चा अथ� मुल�ना लहान वयात लावता येतोच असे नाही. यासाठी आई -

वडल�नी, आजी -आजोब�नी मुल�जवळ बसून अथ� िवशद करावा. वािह�य�चा िवळ�यात मुल�ना मा�यम -

सा�र करणं ही पालक�ची मोठी जवाबदारी आहे.

लागते ते�हा (गिरबीची जाणीव आहे का ? ), परी�ेत अपयश , लॉटरी लागते ते�हा (गिरबीची जाणीव आहे का

?),परी�ेत अपयश आ�यावर , वाढिदवसाला एक�ालाच भरपूर भेटी िमळा�यावर (दसु�य�ना �ा�याशा

वाटतात का ? ), वाढिदवस वेग�या प�तीनं साजरा कसा करता येईल ? (उदा. अनाथा�माला भेट इ. )

आजकाल िक�येक मुलं तासंतास दरूिच�वाणीला िचकटून असतात. या छो�ा पड�ात मुल��या भाविनक

िव�वाला हात घाल�याचं �चंड साम�य� आहे.

िदवसातले आनंदाचे - दःुखाचे �संग रोजिनशीत िलहायची मुल�ना सवय लावावी. यश�वी माणसं नुसती

बु�यंका�या बळावर मोठी होत नाहीत. हाताखाल�या लोक�ची �य�ना काळजी असते. ��येकासाठी �य��या

मन�त जागा असते. दसु�य�नी आपला आदर करावा असे वाटत असेल तर आपणही �य�चा आदर केला

पािहजे. ही सवय लहानपणापासूनच लावावी लागते. �हणून काम करत�ना कधी कुणाला नकळत दखुावलं

का हे आठवावं आिण रोजिनशीत ज�र नमूद करावं.

असतात. �यातून हा�यिवनोदा�या �व�पातील करमणूक होते. मुल��या भावन�ना हात घालेल अशा �व�पाचा

�य�न िदसत नाही. काटू��स पहात�ना मुलं हसतात पण रडत नाहीत. अगदी अिलकडे मा� काही काटू��सम�ये

भावभावन�चे िच�ण िदसते. (उदा. ' �पायडरमॅन ', ' �के-टू ')

जो पु�तकी �ान आिण तं��ानानं मोठा होतो �याचा बु�यंक जा�त असतो. माणुसकीची जपणूक करतो.

�याचा भावन�क जा�त असतो. रोजिनशी हे मुल�चा भावन�क वाढवणारं, घर�या शाळेतलं पु�तकच.

बु�यंकाला भावन�काची जोड देणारं !

आपण दस�याला सर�वतीची पूजा करतो. यंदा�या दस�यापासून िश�क�नी आिण पालक�नी मुल�ना

रोजिनशी िलहायला उ��ुत करावं. मुल��या भाविनक आयु�यातलं हे मोठं सीमो�लंघन ठरेल.

घरात काही गोडधोड के�यास कामवा�या बायक�ना �कवा घराजवळील एखा�ा गरीब कुटंुबाला �ावे. �हणजे

िमळालेले सगळे एक�ानेच हडप करायचे अशी आ�मक� ि�त वृ�ी िनम�ण होत नाही.

काही मूळ उतावळी असतात, काह�ना लगेच राग येतो, तापट असतात. अश�ना समजावून �ावं लागत. तुझं हे वत�न

आज घरात आहे �हणून ठीक आहे, आ�ही चालवून घेतोय पण ते सव� मा�य नाही याची िनदान जाणीव क� �ायला

पािहजे. जवळ बसून गोडीगुलाबीत �कवा गो�टी �पाने हे स�गावं.

एकदा एका िठकाणी भाषणाला जायचा यो� आला. भाषणात एक गो�ट स�गत होतो गणपती�या लहानपणाची.

गणपतीला ह�ीचे डोके बसवतात असं स�गत असत�ना एक मुलगा हमसून हमसून रडायला लागला. 'बाळ काय झालं

कुटंुबात�या जवळ�या नातेवाईक�पैकी कोणावर काही गंड�तर आलं िक अशा वेळेस मुल�ना पण यो�य श�दात �संग

समजावून स�गावा. �य�ना पण बरोबर �यावे. दसु�याच दःुख, अडचण जाण�याची, समजाव�याची, सहवेदना िनम�ण

झाली पािहजे. अरेरे ! वाईट झालं ! िबचारा अशी सहानुभूती नको. पालक�नी �य�नपूव�क संवेदनाच संगोपन

करायचंय.

आजकाल आई वडील मुल�साठी खूप क�ट घेतात. सकाळी उठ�यापासून रा�ी झोपेपय�त राबराब राबतात. मुल�ना या

क�टाची जाणीव असतेच असं नाही. आई गावाला गेली �कवा एक - दोन िदवस आजारी पडली तरच बाब�ना �कवा

ताईला थोडंफार काम करावं लागत आिण मग आई रोज िकती क�ट घेते याची जाणीव होते. घरात �ीमंती असली तरी

मुल�ना पै�याची जाणीव क�न देऊ नये.

आपण �वतः आिलशान घरात राहतो पण इतर मुले कुठे रहातात हे मुल�ना कळलं पािहजे. अनाथा�म,

िरम�डहोम, झोपडप�ी, भट�या लोक��या व��या अशा िठकाणी ��य� जाऊन बघणं श�य आहे. �य��या जागी

तु�ही असता तर तुम�या मनात काय आलं असतं, �या भावना मुलाला िलहायला स�गा�यात. गडिचरोली, धरणी

(अमरावती ), धडगाव (नंदरुबार ), ज�हार , मोरवाडा (ठाणे ) या आिदवासी भागात मुल�ना सहली�या िनिम�ाने

श�य असेल ते�हा घेऊन जावे आिण आिदवासी ब�धव�ची पिर��थती �य�ना डो�य�नी बघू �ावी. वेगवेग�या

अनुभव�नी आपण अ�व�थ होतो ते�हा आपला अनुभव इतर�पय�त पोहोचावा असे वाटू लागते. �या अनुषंगाने

श�द सुचू लागतात. मन अिधकािधक िवचार क� लागतं. या �ि�येतच मनाची संवेदनशीलता वाढते.

तुला ?' असं िवचार�यावर रडतच तो �हणाला ' काका �या ह�ीचं डोकं कापून गणपती बा�पाला बसवलं �या ह�ीचं पुढे

काय झालं असेल ?'

मनात सुखद आ�चय�चा तरंग उमटला - आहे, अजूनही संवेदनशीलता जागी आहे.

मुल�ना आपण शाळेत िश�ण देतो ते म�दिूश�ण. हात�नी कौश�या �ा�त करायला िशकवतो ते ह�तिश�ण आिण

संवेदना जाग�क करत ते �दयिश�ण. �ा तीनही �कार�या िश�णातून मूळ िश�ण सुंदर िदसू लागत. िनर�र,

अडाणी �य�तीला सु�ा या मुलाकडे बघून �य��यासारखचं िश�णसुंदर िदसावं असं वाटलं पािहचे

Activities of IAP Branch

Navi Mumbai

Nagpur


Pune

Solapur


Pune


Raigad


Aurangabad


Yavatmal


IAP Akola


Chandrapur


Nashik

Branch Name Secretary President

AHMEDNAGAR DR DEEPAK R KARPE DR SAGAR WAGH

8975824188/7058673104 9422791933

[email protected] [email protected]

AKOLA DR ATUL KALPANDE DR SANDEEP MANKAR

9860640062 8411980969


AMRAVATI DR KAUSTUBH DESHMUKH DR PANKAJ V BARABDE

9890456560 9422169075/9922500976


AURANGABAD DR SAGAR S KULKARNI DR PRASHANT S PATIL

9823138360 9822424006


BARAMATI DR BHASKAR V JEDHE-DESHMUKH DR RAJENDRA M MUTHA

9822402772 9823017123


BEED DR BAIG MM SHUJAAT DR PANDURANG C TAMBADE

9021232600 8975922007


BULDHANA DR GAURAV G LADDHA DR HARI W WADODE

9969941626 9422180277


CHANDRAPUR DR ABHILASHA K GAOTURE DR APARNA S ANDANKAR

9158987292 9822707866

[email protected]

DHULE DR DADA BHAI PATIL DR SACHIN DEVIDAS DHOLE

9594955099 9822343053


GONDIA DR SANDEEP R KOTHARI DR JULIE C CHHABDA

9860975586 9823102799


Office Bearers List of all IAP Branches of Maharashtra State


HINGOLI DR VENKATESH K DAMKONDWAR DR SNEHAL I NAGRE

9850421170 9422175927


JALGAON DR MANDAR S KALE DR AJAY M SHASTRI

9970375153 9423974944/9822826327


JALANA DR ASHWINIKUMAR R KATHAR DR SANJAY B JAGTAP

9422290466 9823380017


KALYAN-DOMB. DR NIKHIL KULKARNI DR HEMRAJ ASHOK INGALE

8082789345 9820454459


KARAD DR KISHORKUMAR B CHAVAN DR SHAMSUNDAR V THORAT

9423827790 9422600712


KHAMGAON DR GAURAV LADDHA DR HARI W WADODE

9146185604 9422180277


KOLHAPUR DR SAINATH PAWAR DR DEEPA S PHIRKE

9890168895 09850074565


KOPARGAON DR AMOL AJMERE DR APPASAHEB S ADIK

9850244244 09921189911


LATUR DR NITIN JAISWAL DR SHIVPRASAD K MUNDADA

9422611007 9325094754


MALEGAON DR DEEPAK K PAWAR DR DATTATRAY B TALE (PATIL)

9422942727 9422271460




MUMBAI DR AMIN KABA DR BELA VARMA

9323541534/9323547725 9820847083


NAGPUR DR MAHESH NATHUJI TURALE DR RAVINDRA B BHELONDE

8087987434 9823298303


NANDED DR RAMRAO G SHRIRAME DR RAJESH BHASKAR NOONE

9545359500 9823208717


NANDURBAR DR GAVRI R SHAHA DR ALKA S KULKARNI

9881486831 9422753245


NASHIK DR SANDIP J PATIL DR SANJAY M AHER

9011518175 9960636509


NAVI MUMBAI DR JEETENDRA GAVANE DR SHILPA P AROSKAR

9870106094 9821259713


OSMANABAD DR PRASHANT B MORE DR DATTU S THITE

9422464649 9422069720


PALGHAR DR SHAILESH R BAROT DR ARCHANA H JOSHI

8830272454 9823366948


PARBHANI DR ABHIJEET CHIDWAL DR MOHD ABDUL RAZZAK SHAIKH

9860291641 9422189027


PANDHARPUR DR SHRIKANT K DEOKATE DR SHITAL SHAH

9822148250/9822148150 9822086691



PUNE DR PARAG B GAIKWAD DR SANJAY V MANKAR

8796527470 9422078779


RAIGAD DR PRAMOD A WANKHEDE DR HEMANTKUMAR R GANGOLIA

9823038046 9822956846


RATNAGIRI DR VIJAYKUMAR A SURYAGANDH DR NILESH R SHINDE

9822983610 9923576006


SANGALI DR SUDHIR ARUN MAGDUM DR SUHAS D BHAVE

9850787799 9823030236


SATARA DR GAVRI R SHAHA DR SANJAY K GHORPADE

9881486831 9822057577


SANGAMNER DR SANDIP G HON DR OMPRAKASH SIKCHI

09850264611 9850250723


SINDHUDURG DR HARISH ARUN PARULEKAR DR PRASHANT G MOGHE

9422434753 9422434188


SOLAPUR DR ANNASAHEB E LOKHANDE DR SAMEER KHAN

9970174526 9422066933


[email protected]

THANE DR SACHIN A BIRADAR DR SANJAY SHANKAR HENDRE

9820203524 9821218029


WARDHA DR AMOL C LOHAKARE DR RAJENDRA R BORKAR

9370316646/7774808322 9822240837


WASHIM DR KIRAN R BAGADE DR RATNESH PARALKAR

9004387803 9422791719


YAWATMAL DR SARANG TARAK DR VIRENDRA RATHOD

9404280048 9822576227



mhaiap final 18 virsionmahaiap.org/mahaiap.pdfmaharashtra state branch of india academy of...

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