• A new oral rehydration treatment for cholera has been found to reduce diarrhea in addition to correcting dehydration (New Engl J Med 2000; 342; 308). In this randomized study on 48 adolescents and adults with cholera, adding maize starch to the standard glucose based solution significantly reduced the amount and duration of diarrhea. It’s another small step towards an effective and acceptable treatment for cholera, comments an accompanying editorial.
  

• A live, attenuated trivalent intranasal influenza vaccine has been found immuno-genic and efficacious in children, and protected against a strain that was not contained in the vaccine. This 2-year multi-center study has found that the intranasal vaccine was well tolerated and immunogenic, with 82% to 100% of those vaccinated becom-ing seropositive for influenza antibodies. Moreover, antibodies to the variant strain A/Sydney/H3N2, not included in the vaccine, was also found in those vaccined (J Pediatr 2000; 136: 168). An accompanying editorial says that though this live, attenuated influenza vaccine promises to be a valuable addition to the options available for the prevention of influenza, the concerns which need to be addressed are the risk of secondary infections after epithelial disruption caused by the vaccine virus and the potential risk posed by inadvertent administration of the vaccine to immunocompromised hosts (J Pediatr 2000; 136: 139).
  

• The treatment of streptococcal tonsillo-pharyngitis continues to be in news. A meta-analysis on the cure rates after a twice daily (BID) or once-daily versus more frequent dosing schedules supports current recom-mendations for BID dosing of 10 day course of penicillin in treating streptococcal tonsillopharyngitis. Once daily penicillin was associated with decreased efficacy and should not be used while simplified regimens of amoxicillin of shorter duration or of less frequent dosing need further investigation (Pediatrics 2000; 105: e19).
  

• Intransal beclomethasone dipropionate though considered safe at recommended doses, may have adverse long term effects on growth. A study on 100 prepubertal children with perennial allergic rhinitis who were treated with aqueous beclomethasone 168 mg twice daily (n = 51) or placebo (n = 49) for 1 year found the overall growth rate was significantly slower in treated subjects. The difference in growth rates was evident as early as the 1-month treatment visit, suggesting that the effect on growth occurred initially. This study suggests, that intranasal BDP may slow growth rate in children without suppressing basal 6 AM cortisol concentrations or the response to cosyntropin stimulation, which are commonly used clinically to test for adrenal suppression. The authors conclude that dose-reduction strategies should be considered to minimize the risks of systemic corticosteroid exposure (Pediatrics 2000; 105: e 23).
  

• Asthmatic children appear to have a significantly higher frequency of gastro-intestinal complaints than do other children. A study on 75 children with bronchial asthma and 75 healthy controls found a total of 28 in the asthma group were symptomatic versus 9 in the control group, with vomiting, diarrhea and abdominal pain being the common symptoms. No associations, however were seen between gastrointestinal symptoms and asthma severity, frequency, or medication use. The researchers call for further investigation to determine whether any modification of diet would affect the prevalence or severity of both abdominal complaints and asthma in such patients (Arch Dis Child 2000; 82: 131).
  

• A polymorphonuclear (PMN) predomi-nance as a sole criterion does not discriminate between aseptic and bacterial meningitis. These were the findings of this study on 158 cases of meningitis (138 aseptic and 20 bacterial). The study found that a majority of children with aseptic meningitis had a PMN predominance in the CSF with the predomi-nance not being limited to the first 24 hours of illness (Pediatrics 2000; 105: 316).
  

• A low cost device could help in early detection of hypothermia in neonates. This device, a liquid crystal temperature dot called Thermospot, consists of a 12 mm sticky black disc which is placed high in the axilla or over the liver area in the epigastrium. Provided that the newborn babies’ temperature is 35.5°C or more, the black disc changes to a green smiling face. If, however, the temperature falls below 35.5°C the disc reverts to black, and indicates immediate initiation of warming measures. Though they do not have sufficient clinical data to support its routine use in newborn, the authors conclude that this device could prove useful in developing countries, where hypothermia is common (Lancet 2000; 355: 659).
  

•  The severity of diarrhea in rotavirus infection is probably due to the stimulation of the enteric nervous system (Science 2000; 287: 491). Though this is the mechanism for diarrhea in Cholera and Escherichia coli, this is a new and important finding about the rotavirus, which kills thousands of infants each year. This finding could have a significant implication on developing a specific treatment for rotavirus infection which is presently limited to maintaining the fluid balance.
  

•  The increasing resistance to cheap and efficient treatment like chloroquine and Fansidar for uncomplicated malaria is becom-ing a cause for concern. In this study on 600 Gambian children with malaria, the addition of artesunate (4 mg/kg) to pyrimethamine-sulphadoxine was found to be well tolerated, provided faster symptomatic relief and was more effective in decreasing the gametocy-temia as compared to pyrimethamine-sulpha-doxine alone, a regime widely used as a replacement for chloroquine. The addition of artesunate to each malaria treatment results in lower gametocyte rates, lower transmission rates and may help avert the predicted malaria disaster (Lancet 2000; 355: 352).
  

• El Nino, a climatic phenomenon, which has been linked with an increasing incidence of illnesses such as malaria, cholera and dengue fever, has now been connected with an increase in childhood diarrhea. A study of 57,331 children in Lima, Peru, found that an increase in diarrhea cases between 1993 and 1997 was linked to even small rises in temperature, regardless of whether it was summer or winter. A one degree centigrade rise in temperature was associated with a 8% increase in incidence of diarrhea. El Nino may be associated with behavioral patterns more common during warm weather, such as increased demand for water and less con-scientious hygiene practices, which are known to promote diarrhea transmission (Lancet 2000; 355: 442).
  

• An early molecular response during induction chemotherapy predicts an excellent outcome in children with acute lymphoblastic leukemia. In a study on 68 children with median age 4.4 years, though all children went into morphologically complete remission after induction therapy, low levels of residual disease at day 15, as determined by molecular methods, identified children with excellent outcomes, who may be candidates for less aggressive therapy (Blood 2000; 95: 790).
  

• Antibiotics need not be prescribed in the first visit in cases of acute otitis media, provided close surveillance can be guaranteed. These are the findings of a study on the efficacy of amoxicillin as an initial treatment for acute otitis media in 240 children aged 6 months to 2 years. It was found that though prescription of amoxicillin at the first visit reduced the median duration of fever, it did not affect the duration of pain or crying clinical symptoms and otoscopy results at day 11, or improve tympanometry findings at 6 weeks. (BMJ 2000; 320: 350).
  

• Widespread use of growth hormone may not be justified. A study on 23, 233 children treated with growth hormone found that children with concomitant glucose intolerance who have been treated with growth hormone (GH) develop type 2 diabetes at a rate six times that of children not treated with GH. Discontinuation of GH therapy did not resolve type 2 diabetes. According to the authors, GH therapy may have hastened the onset of type 2 diabetes that would have occurred in adult life without GH therapy. The authors recom-mend blood sugar determination before starting GH therapy and follow-up of children with disorders at high risk of type 2 diabetes mellitus (Lancet 2000; 355: 589). A related editorial advised caution in widespread use of GH in view of the increasing reports of adverse effects (Lancet 2000; 355: 610).
  

• Low birth weight has been linked to insulin resistance syndrome later in life. The investigators studied 627 Chinese men and women, mean age 45, whose birth weights were known and whose mothers’ heights and weights had been recorded during pregnancy. Those with low weight were associated with increased prevalence of the insulin resistance syndrome of higher blood sugar, insulin and triglyceride levels in adult life. The lower birth weight was closely associated with lower body mass index of the mother, suggesting that thinness of the mother during pregnancy is associated with insulin resistance and reduced glucose tolerance in adult offspring (Ann Intern Med 2000; 132: 254). According to another study, being born low birth weight does have its disadvantages, but they do grow into socially well adjusted adults despite academic and economic disavantages. These were the findings from an analysis of data of the 1970 British birth cohort (JAMA 2000; 283: 625).

C. Vidyashankar,
Department of Pediatrics,Base Hospital, 
Delhi Cantonment,
Delhi, 110 010,
 India.