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BCG may not be the most effective vaccine against
TB; however it may have some "side - benefits". In this study the
authors examined whether BCG-vaccinated children with a BCG scar or a
positive tuberculin reaction had better survival than children without
such reactions. BCG scar and a positive tuberculin reaction were
associated with better survival in early childhood in an area with
high mortality. The authors conclude that the effect of BCG
vaccination could be due to non-specific immune-stimulation protecting
against other infections. Vaccine 2003; 20(21-22): 2782
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An unusual study was done to assess the risk of
childhood leukemia associated with allergies or a family history of
allergy. The study included a total of 1,130 cases of acute
lymphoblastic leukemia (ALL), 164 cases of acute myeloid leukemia
(AML) and 2,957 controls. A major finding of the study is that hay
fever, neurodermatitis and contact eczema are underrepresented within
the group of children with ALL. No such consistent pattern is seen for
AML. This data would suggest that atopy or a family history of atopy
are associated with a reduced risk of childhood ALL. Int J Cancer
2003; 105: 255
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C-reactive protein (CRP) is used as a nonspecific
marker of inflammation. Additionally, it also appears to be a
prognostic marker in several malignancies. The authors analyzed CRP
serum levels in 95 consecutive pediatric and adolescent patients with
Hodgkin disease. At the time of diagnosis increased serum CRP levels
were found in 64 % (61/95) of the patients; CRP levels correlated with
stage and were higher in patients with B symptoms. Higher CRP levels
were associated with an increased risk of relapse. CRP holds promise
as a diagnostic and prognostic index and follow-up monitor in
pediatric and adolescent patients with Hodgkin disease, and merits
further investigation. Med Pediatr Oncol 2003; 41: 21
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In a study that may create some controversy,
authors from AIIMS have concluded that mass vaccination against HAV is
NOT required in north India because of the presence of protective
antibodies against HAV in the majority of the population. This result
was based on a study involving 1424 govt. school children and 256
patients with chronic liver disease. A total of 93.2% (1328/1424) of
the school children between 4-18 years of age who were included in the
study had anti-HAV antibody in their sera. Of the patients with
chronic liver disease 97.6% (248/254) had anti-HAV antibody in their
sera. J Gastroenterol Hepatol. 2003; 18: 822
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Newborn heel stick blood collection can be a
painful procedure in part because of the time required to obtain
sufficient quantity of blood. To determine if the topical application
of Nitroglycerine ointment (a vasodilator) would reduce the time
needed to collect the required amount of blood for newborn metabolic
screening and, in turn, reduce the pain/distress of the procedure, a
randomized trial was carried out in 50 term newborns. There was no
statistical difference between groups in collection time, crying time
or number of heel sticks required for completion. Thus the authors
conclude that topical Nitroglycerine did NOT facilitate heel stick
blood collection or reduce the pain/distress of the procedure. J
Perinatol 2003; 23: 304.
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Evidence based medicine is fast becoming the
buzzword in medicine. This article reviews the strength of the
evidence that underlies the current approach to the management of
childhood epilepsy. The authors reviewed published, peer-reviewed
English literature accessed through PubMed and Cochrane reviews with
evidence rated as Class 1 (strongest) to Class 4 (weakest). They found
that there is considerable inaccuracy in the diagnosis of seizures and
epilepsy syndromes. The diagnosis of epilepsy should await two
unprovoked seizures. Population-based studies indicate that remission
from childhood onset epilepsy occurs in at least 50% of children.
Absence of concomitant neurologic handicap and onset before about 12
years of age are the most consistent predictors of remission. Social
outcome appears unsatisfactory in about 50% of cases without
intellectual handicap. Death is rare in childhood. J Child Neurol
2003; 18: 272
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What are the medical options in cryptorchidism? To
compare the effects of medical therapy on boys with cryptorchidism, a
prospective study was carried out in five groups of patients (total
no. 324) over a 30-month period. In the author’s experience, pharmaco-logical
treatment seems to yield better results in cases of bilateral than
unilateral crypt-orchidism. hCG seems to be equally effective as LH-RH
for the treatment of cryptorchidism in approximately 30% of cases; the
combina-tion of these two drugs does not seems to increase the success
rate. The use of hMG alone is ineffective. Scand J Urol Nephrol 2003;
37: 246.
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Does adenotonsillectomy improve growth in children
with obstructive adenotonsillar hypertrophy? This study included 29
pre-pubertal children with obstructive adeno-tonsillar hypertrophy,
and aimed to investigate the probable difference in energy intake and
serum insulin-like growth factor 1 (IGF-1) and insulin-like growth
factor binding protein 3 (IGFBP-3) levels before and 6 months after
adenotonsillectomy. Weight and height standard deviation scores,
energy intake per kilogram and serum IGF-1 levels were found to be
significantly higher 6 months after adeno-tonsillectomy, indicating
that adenotonsillar hypertrophy is associated with poor growth. J Int
Med Res 2003; 31: 84.
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Intractable epilepsy can be a frustrating
experience for the parents and physician alike. There have been few
reports of steroid use in children with epilepsy outside the first
year of life. This report states the experience with prednisone for
the treatment of 28 older children (1.5 to 10 yr) with intractable
epilepsy. The follow-up period was for 1 to 5 years. Thirteen patients
(46%) became seizure free on prednisone and another 18 (40%) had a
significant decrease in seizure frequency. The best outcomes were seen
in the children with absence seizures and Lennox-Gastaut syndrome.
Side effects were uncommon. Pediatr Neurol 2003; 28: 194.
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The diagnosis of pyelonephritis is primarily
clinical. However, the history and physical findings can be confusing
in children, leading to adjunctive DMSA nuclear renal scan to confirm
the diagnosis. Nonetheless, ambiguity occurs when differentiating
between acute pyelonephritis and chronic scarring. The authors report
their initial experience in 9 patients with gadolinium enhanced MRI to
diagnose acute pyelonephritis. All patients had at least 1 prior
episode of clinical pyelo-nephritis. MRI provided greater anatomical
detail regarding the renal architecture with- out radiation exposure,
and allowed the unambiguous diagnosis of acute versus chronic
pyelonephritis scar in a 1-time (versus often multipart for DMSA)
imaging study and it proved to be more cost-effective. J Urol 2003;
169: 2308.
