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- The integrated
management of childhood illness strategy (IMCI) aims to
improve the skills of health workers, the health system
itself, by the use a clinical algorithm to detect the
commonest causes of childhood illness and by providing desktop
guidelines for history taking and examination. The response in
Africa has been quite encouraging. The benefits of the
training appeared to include more rational drug use, increased
attendances, correct management of diarrhea, improved
immunization services, weighing of children, provider morale
and perceptions of quality of care by mothers. A positive
effect of the training on outcomes such as child mortality was
more difficult to demonstrate, as nearly 80% of childhood
deaths in Africa occur at home (BMJ 2000; 320: 594).
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- Bullying is still prevalent in
schools with undesirable consequences for the victims as well
as the bullies. A study comparing 92 adolescents who had been
below the third centile for height at school entry and 117
controls matched for age and sex reported that short boys were
more than twice as likely as control boys to be victims and
much more likely to be upset by bullying. Significantly more
short pupils said that bullying had started in junior school.
These reports are in contrast to the previous studies that
found few significant psychosocial problems attributed to
short stature (BMJ 2000; 320: 612).
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Breastfeeding
by HIV positive mothers is associated with risks of
transmission to the infant. This randomized study from Nairobi
adds to the increasing reports on the negative aspects of
breastfeeding by HIV positive mothers. This study puts the
risk of trans-mission at 16.2% with the transmission occurring
early in a breastfed infant’s life. By the end of two years,
58% of the breastfeeding women had a living child who was free
from infection, whereas in the formula feeding group the
figure was 70%. The study con-cluded that complete avoidance
of breast feeding will reduce the risk and be associated with
a significantly improved HIV-1-free survival (JAMA 2000; 283:
1167).
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- Seizures commonly complicate
cerebral malaria and are associated with an increased risk of
death and neurological sequelae. Intramuscular phenobarbitone
is not a safe modality of treatment in these circumstances.
These were the findings of a randomized study on 340 children
with cerebral malaria in whom phenobarbitone was used in a
dose of 20 mg/kg. Though the seizure frequency was
signi-ficantly lower in the phenobarbital group than in the
placebo group, the frequency of respira-tory arrest was higher
and mortality greatly increased. The authors conclude that the
use of this dose cannot be recommended (Lancet 2000; 355:
701).
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- Measles vaccine by the
aerosolized route has been found to be more effective than the
traditional route. In this randomized study, over 4000 South
African school children received either standard titer doses
of either Schwartz or Edmonston-Zagreb (E-Z) measles vaccines
subcutaneously or E-Z vaccine by aerosol. Blood samples for
antibody assay were collected before vaccination, at 1 month,
and 1 year after vaccination. The sero-conversion for E-Z
vaccine by the aerosol route was 84% at 1 month and 96% by one
year as compared to 78% and 92%, res-pectively for the
subcutaneous route. The seroconversion rates of the Schwartz
vaccine (subcutaneous) were much lower. There were no serious
side-effects. Aerosol vaccination method is effective,
acceptable and adaptable to mass campaigns for measles
eradication (Lancet 2000; 355: 798).
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- Thumb-in-fist (TIF) posturing in
infants is an interesting clinical finding that has attracted
little attention. A study of its prevalence, resolution, and
clinical associations were carried out on 200 apparently
healthy full-term newborn infants. The whole study group was
followed up until the disappearance of the TIF occurred.
Thumb-in-fist was noted in 62.5% of infants with a mean age of
disappearance of 1.5 months. The only association noted
between age of resolution of the TIF and the
neurodevelopmental status was a delay in language attainment
at the 12-month screen-ing. Therefore, a TIF posture after
this age should alert the clinician to the possibility of
possible neurological dysfunction (Pediatrics 2000; 105: e41).
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- What are the predictors of a
relapse in Nephrotic syndrome? A study on 56 children with
nephrotic syndrome (M = 38, F = 18) analyzed the following
variables – age, sex, race, hematuria, and days to achieve a
remis-sion, as predictors for a future relapse. The study
found that of all the presenting features, the delay in the
initial response to steroid therapy combined with the presence
of hematuria, could predict future relapses and should be used
as a clinical indicator in child-hood nephrotic syndrome
(Pediatrics 2000; 105: 492).
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- ntraventricular hemorrhage (IVH)
is a complication that is usually associated with adverse
neurodevelopmental outcome in pre-term neonates. Early use of
low-dose indo-methacin treatment is associated with a decrease
in both the incidence and severity of IVH in these cases. In a
study regarding its adverse effects on neurodevelopmental
mile-stones, 384 infants of the Multicenter Randomized
Indomethacin IVH Prevention Trial were followed up till 54
months of age. The study found that there was no effect of
indomethacin on neurodevelopmental function at 54 months of
age. The authors concluded that use of indomethacin is safe
and without adverse effects on neurodevelopmetal function
(Pediatrics 2000; 105: 485).
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- Extraimmunization is now a
problem in the United States! The extent and cost of
extraimmunization - vaccine doses given in excess of the
recommended schedule, was studied. Overall, 21% of children
were extra-immunized for at least 1 vaccine vs 31% under
immunized. Frequency of extraimmunization was less than 5% for
each vaccine considered except poliovirus (14.1%). In a
multivariate model, the strongest contributors to
extra-immunization were having more than one immunization
provider. The study concludes that extraimmunization can be
costly and should be reduced without interfering with more
important efforts to combat under-immunization. Improvements
in immunization record keeping and sharing practices may help
reduce extraimmunization (JAMA 2000; 283: 1311).
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