|
-
Reactivation of the vaccine virus can occur with the varicella
vaccine. Though the symptoms are expected to be mild, it does merit
further study. In a follow up of over 4000 children who received the
oka VZV vaccine, in subjects who initially had high anti-VZV titers,
titers tended to decline during the 4 years of the study, while in
those whose initial response to the vaccine was weaker, titers
increased over time. This rate was considerably higher than that
expected from exposure to wild-type virus, and hence is attributable
to reactivation of the vaccine virus. The authors state that the
capacity to induce latent infection and to become reactivated are
probably useful properties for VZV vaccine if they boost and maintain
lifelong immunity and the reactivation events are clinically
inconsequential. An accompany-ing editorial reiterates that even if
the vaccine is ultimately proven to cause some clinical morbidity
attributable to reactivation, its use should certainly not be
abandoned (Nature Medicine 2000; 6: 381, 451).
-
Subcutaneous glucagon
has been found to be effective in pediatric asthma. In a case-control
study from Turkey, 40 children with acute asthma were either given
subcutaneous glucagon (1 mg) or inhaled salbutamol. Both groups showed
significant improvements in respiratory function parameters at 30 and
120 minutes after treatment. In addition, no significant differences
were seen between groups in the magnitude of improvement. Though the
mean blood glucose concentration increased after glucagon
administration, it did not reach the level of clinically important
hyperglycemia. Glucagon treatment, the authors conclude, may be an
alternative to metered-dose inhaler salbutamol as a bronchodilator in
the treatment of acute asthma in children (Pediatr Asthma Allergy
Immunol 1999; 13: 177).
-
Functional defects in
the basal ganglia have been detected in children with attention
deficit/hyperactivity disorder. Using a method known as the functional
magnetic resonance imaging (fMRI), in which the blood flow to various
regions is measured, the defect has been localized to the putamen.
Although the authros stated that this method needs to be tested in
larger studies, the current research may help advance both the
diagnosis and treatment of ADHD. Being able to rely on brain changes
rather than behavior alone might lead to more accurate diagnosis of
the disorder and monitoring of therapy (Nature Medicine 2000; 6: 470).
-
The US government
advisory committee recommended approval of an important new type of
antibiotic for battling drug-resistant infections. The Anti-Infective
Drugs Advisory Committee recommended approval of Zyvox for treatment
of pneumonia, skin infections and vancomycin-resistant Enterococcus
faecium, responsible for causing various drug resistant infections,
including endocarditis. The chemical ingredient is linezolid and
belongs to the group oxazolidinones, a new class of antibiotics that
acts by inhibition of protein synthesis. Zyvox is active against Gram
positive bacteria with a demonstrated in vitro activity against
bacteria resistant to other antibiotics, including methicillin-resistant
Staphylococci (MRS), multi-resistant strains of S. pneumoniae. Though
this does not mean automatic FDA approval, the FDA usually follows the
advisory committee’s recommendations. (CNN Health, 24 March 2000).
-
Mothers of low birth
weight children have a greater chance of death from heart disease.
Though the exact cause has not been explained, in this study of nearly
45,000 women aged 15 to 45 who gave birth between 1976 and 1997, every
1 kilogram reduction in a baby’s birth weight is associated with a
2.2 times increase in mother’s mortality due to heart disease. The
findings in this study agree with one published in 1997 in which the
overall death rates of mothers increased 1.8-fold and their
heart-related death rates doubled with every 1-kilogram reduction in
infant birth weight. The authors believe that the higher death rates
may relate to some as yet undiscovered relationship between the
generations which merits further investigation (BMJ 2000; 320: 839).
-
Recgonition of
television images - A new developmental milestone to look for in
children! The changing times have lead to changes in the milestones
used for testing development. In this study of nearly 800 children
between 8 and 23 months, the parents answered a questionnaire as to
whether or not the child recognized the television image of a cat,
dog, or baby by naming, imitating, or pointing at the image. The
authors noted that at 18 months of age, 96% of normal children
recognized the television image of a cat, dog, or baby. In comparison,
only 5 of 26 (19%) children with Down’s syndrome, who were also a
part of the study could recognize the images. In evaluating the
development of young children who do not talk, recognition of the
television image of a cat, dog, or baby is a simple milestone that can
be tested (BMJ 2000; 320: 836).
-
Bone marrow
transplantation in sickle cell anemia in showing encouraging results.
Two years after matched sibling bone marrow transplantation, most
children have improved growth, stable pulmonary function and improved
cerebral imaging results. In this Multicenter Investigation of Bone
Marrow Transplantation for Sickle Cell Disease of the 26 children with
symptomatic sickle cell disease who underwent matched sibling bone
marrow transplantation, 22 patients had stable donor engraftment and
clinical and subclinical manifestations of sickle cell disease
arrested or eradicated after transplantation. The authors conclude
that new studies are warranted to compare bone marrow transplantation
with other therapeutic options in children with symptomatic sickle
cell disease (Blood 2000; 95: 1919).
-
Use of alternate day
prednisolone in cystic fibrosis has long term adverse effects, long
after the drug is stopped. In this study the growth evaluation in
nearly 150 children with CF who had received alternate day
prednisolone 6-7 years back showed some unexpected results. Even after
the drug has been stopped for a long time, the side effect of growth
impairment in boys persists. Among boys 18 years of age or older, mean
height was a significant 4 cm less in the prednisone group than in the
placebo group. The authors caution these results add to the growing
evidence on long term effects of steroid therapy and advice that the
minimum effective dose should be used. A related editorial states that
focusing on height alone as an important adverse effect of
glucocorticoid therapy in children may be misguided. The editorialists
express concern about the other side effects of long-term
glucocorticoid therapy when alternative methods of anti-inflammatory
therapy are available for children with cystic fibrosis (N Engl J Med
2000; 342: 851, 887).
-
The role of 50%
Nitrous Oxide Oxygen Mixture for Painful Procedures was evaluated
using a questionnaire survey in France. One thousand nineteen
inhalations from 31 centers that participated in this 2-month survey
were analyzed. A wide range of procedures were performed under this
analgesia. Analgesia obtained during procedures was good but this gas
mixture was not efficacious in all patients with the best results
obtained in children less than 3 years. Although minor effects are
frequent during EMONO inhalation, its use seems safe because no single
serious side effect was noted during this study. This helpful method
is still underused, and it should be readily available in each
emergency and pediatric department. (Pediatrics 2000; 105: e47).
-
The long term effects
of iron deficiency continue to be debated. A longitudinal follow-up
study of 191 children managed to evaluate 87% of the cohort at 11 to
14 years of age. The children were free of iron deficiency and growing
normally during the time of study. Those who had chronic, severe iron
deficiency in infancy (n = 48) were compared with those who
had good iron status before and/or after iron therapy in infancy
(n = 114). Children who had severe, chronic iron deficiency
in infancy scored lower on measures of mental and motor functioning,
more specifically in arithmetic achievement, written expression, motor
functioning, behavioral problems and some specific cognitive
processes. Severe, chronic iron deficiency in infancy identifies
children at developmental and behavioral risk (Pediatrics 2000; 105:
e51).
-
A lot of symptoms in
infancy have been attributed to teething. One hundred and twenty five
healthy children were studied in the Cleveland Clinic, Ohio, USA.
Their daily temperatures, the presence or absence of symptoms (among a
list of 18 symptoms) and all tooth eruptions from the 4-month to 1
year of age were recorded by parents. Though many mild symptoms like
increased biting, drooling, gum-rubbing, sucking, irritability,
wakefulness, ear-rubbing, facial rash, decreased appetite for solid
foods, and mild temperature elevation were all statistically
associated with teething; no symptom cluster could reliably predict
the imminent emergence of a tooth. The study concluded that before
attributing any of the infants’ signs or symptoms to teething, other
possible causes must be ruled out. (Pediatrics 2000; 105: 747).
C. Vidyashankar,
Military Hospital, Namkum,
Ranchi, Bihar.
E-mail: [email protected].
|
