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Indian Pediatr 2014;51: 160
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Gaurav Gupta
Email:
[email protected]
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Can we predict pneumococcal bacteremia in patients
with severe community-acquired pneumonia? (J Crit Care.
2013;28:970)
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This cohort study of 108 patients with severe community-acquired
pneumonia (SCAP) admitted to the intensive care department of a
university hospital in Portugal aimed to evaluate biomarkers for
pneumococcal bacteremia in SCAP. Leucocytes, C-reactive protein (CRP),
lactate, procalcitonin (PCT), d-dimer, brain-natriuretic-peptide (BNP),
and cortisol were measured within 12 hours after the first antibiotic
dose. Fifteen (14%) patients with bacteremic pneumococcal pneumonia
(BPP) had significantly higher levels of CRP, PCT, BNP and lactate than
in patients without BPP. The discriminatory power – evaluated by the
area under the receiver operating characteristic curve (aROC) – for PCT
was superior to lactate, BNP, and CRP. At a cutoff point of 17 ng/mL,
PCT showed 87% sensitivity, 67% specificity, 30% positive predictive
value and 97% negative predictive value of 97% for diagnosis of
pneumococcal bacteremia. A PCT serum level lower than 17 ng/mL could
identify patients with SCAP unlikely to have pneumococcal bacteremia.
Given the likely high morbidity and mortality of SCAP
in India, it would be worthwhile to know which cases are likely to have
bacteremia, and thus risk for serious complications. However, PCT is
currently expensive, and not easily available in most Indian settings –
limiting its usefulness in our context.
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Higher vitamin-D levels in pregnancy could
help babies become stronger (J Clin Endocrinol Metab.
2014;99:1)
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Low vitamin-D status has been linked to reduced muscle strength in
adults and children, but little is known about how its variation in
antenatal period affects the progeny. The 678 women who took part in the
study are part of the Southampton Women’s Survey – one of the largest
and best characterized such studies globally. In this study, vitamin-D
levels were measured in 678 mothers in the later stages of pregnancy. At
the age of 4 years, grip strength and muscle mass were measured in
children. The study documented that higher levels of vitamin-D in the
mother were associated with higher grip strength and higher muscle mass
of the child.
If this greater muscle strength observed at 4 years of
age tracks into adulthood, it may help to reduce the burden of illness
associated with loss of muscle mass in old age.
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Reduced atopic dermatitis risk in extremely preterm born
infants (Br J Dermatol. 2013;169:1257)
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It is not yet known whether the risk of developing atopic dermatitis
(AD) is influenced by preterm birth. Moreover, risk of AD has not been
assessed in a large sample of extremely preterm infants. The authors of
this study investigated the relationship between gestational age (GA)
and AD using data from two independent population-based cohort of 2329
preterm infants (479 extremely preterm). Lower proportion of children
with in the extremely preterm group had AD compared with those born at a
greater GA (2-year outcome: 13·3% for 24-28 weeks, 17·6% for 29-32
weeks, 21·8% for 33-34 weeks; 5-year outcome: 11% for 24-28 weeks, 21·5%
for 29-32 weeks, 19·6% for 33-34 weeks). After adjusting for
confounders, a lower GA (< 29 weeks) was significantly associated with
decreased risk of AD.
At least there is some medical problem which extremely low birth
weight babies are less likely to suffer as compared to their heavier
peers!
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Protection by BCG against tuberculosis: a
systematic review of randomized controlled trials [Clin
Infect Dis. 2013;Dec 13. (Epub ahead of print)]
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Randomized trials assessing BCG vaccine protection against tuberculosis
have widely varying results, for reasons that are not well understood.
In this systematic review, the authors examined association of trial
setting and design with BCG efficacy against pulmonary, and miliary or
meningeal tuberculosis. They identified 18 trials reporting pulmonary
tuberculosis, and 6 on miliary or meningeal tuberculosis. Univariable
meta-regression indicated efficacy against pulmonary tuberculosis to be
greatest in children stringently tuberculin tested, to try to exclude
prior infection with M. tuberculosis or sensitisation to
environmental mycobacteria. Protection was weaker in children not
stringently tested and older individuals stringently or not-stringently
tested. Protection was higher in trials further from the equator where
environmental mycobacteria are less and with lower risk of diagnostic
detection bias. There was no evidence that efficacy was associated with
BCG strain. Protection against meningeal and miliary tuberculosis was
also high in infants and children stringently tuberculin tested. Absence
of prior M tuberculosis infection or sensitization with environmental
mycobacteria is associated with higher efficacy of BCG against pulmonary
tuberculosis and possibly against miliary and meningeal tuberculosis.
Evaluations of new tuberculosis vaccines should account for the
possibility that prior infection may mask or block their effects.
Comment: Given the serious doubts that many of us have regarding BCG
efficacy, this review sheds new and useful evidence which confirms that
BCG at birth is probably most effective. Delay in BCG vaccination is
likely to lead to decreased efficacy, and should be avoided.
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