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Amit P Shah
Email:
[email protected]
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Antacid responsible for increased infection risk in
children? (JAMA Pediatr. 2014;DOI:10.1001/jamapediatrics.2014.696.)
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The use of H-2 Receptor antagonist in children for suspected
gastroesophageal reflux disease has increased to a great extent in last
few years. This prospective study associated the use of H-2 Receptor
antagonist with increase in bacterial growth in stomach. Children
treated with H-2 receptor antagonists had more than double the rate of
bacterial growth in the stomach compared with untreated children. Almost
50% of the children treated with antacid had more bacterial growth than
those without treatment. It was also found that the growing use of acid
suppressors in children has been accompanied by an increase in
respiratory tract infections, pharyngitis, gastroenteritis, and
Clostridium difficile colitis.
We must understand that any benefit of acid
suppression should be weighed against potential risk, particularly in
the immunocompromised host.
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Cerebral oxygenation drops when preterm babies
sleep in prone position (Pediatrics.
2014;134:435-45,598-9.)
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Sleeping in prone position is a major risk factor for sudden infant
death syndrome (SIDS), and it is known that 29% of SIDS victims are
preterm infants. In this study, cerebral oxygenation and blood pressure
during sleep in the prone and supine positions were measured in preterm
infants across the first six months post-term , and results were
compared with those from term infants. Cerebral tissue oxygenation index
in preterm infants was significantly lower in the prone position than in
the supine position in both quiet sleep and active sleep at two to four
weeks, two to three months, and five to six months corrected age. It was
higher in quiet sleep than in active sleep in both sleep positions at
two to four weeks corrected age, but lower in quiet than in active sleep
at five to six months.
Preterm infants may be particularly vulnerable to
critically impaired cerebral oxygenation in the prone position,
particularly in the presence of cardiovascular instability, contributing
to their heightened risk of SIDS. So we must suggest avoiding prone
position in all preterm babies to prevent risk of SIDS.
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Sleep consolidates memory of new motor task (NeuroImage.
2014:99:50-8.)
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The consolidation of motor sequence learning is known to depend on
sleep. What is the state of brain during sleep? Is it resting? The
answer is big NO and this study just confirms that. A good night’s sleep
leads to greater consolidation of a newly learned motor task than
performing the same task not followed by sleep. The aim of the study was
to directly compare changes in functional connectivity related to the
consolidation process of a motor memory in two groups of young adults.
Changes in connectivity within the cortico-striatal network were
significantly different depending on whether participants had slept or
not. When someone practices a motor task during the day, it does not
mean that the task-related activity is abolished as soon as practice has
stopped. There may be exciting brain activity going on during sleep that
results from the activity in particular brain areas that were recruited
while you were involved in practice. The author of the study concludes
by saying: "In our society today, we equate sleep and sleepiness with
laziness and depression and other defects of character and where sleep
deprivation is held out as a badge of honor. When in fact, any degree of
sleep deprivation will impair performance and will impair learning. This
is good evidence that the brain is not resting during sleep — it is
consolidating memories and performing extremely important memory-related
functions. Sleep is important."
We must pass on this important message to all adolescents.
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New, rapid sickle cell test
(Proc Natl Acad Sci US A. 2014;Sep 2: pii: 201414739.)
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Although effective low cost interventions exist, child mortality
attributable to sickle cell disease (SCD) remains high in our country
due, in large part, to the lack of accessible diagnostic methods. Here
is the importance of point-of-care technology in our day-to-day setting.
Red blood cells with a high density (ñ > 1.120 g/cm3) are characteristic
of sickle cell disease. This study demonstrates a density-based
separation of red blood cells in a system of aqueous multiphase polymers
that enables a visual test that identifies sickle cell disease, starting
from samples of whole blood, in less than 12 minutes. This low-cost,
simple test could provide a means to enable diagnosis of sickle cell
disease in our low-resource settings and enable life-saving
interventions for children with the disease. The method itself provides
a demonstration of the use of a biophysical indicator (here, density)
rather than a biochemical marker (e.g., proteins separated by gel
electrophoresis) as a means to do point-of-care hematology.
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Iron fortification adversely affects the gut
microbiome, increases pathogen abundance and induces intestinal
inflammation in infants (Gut. 2014;Aug 20: pii:
gutjnl-2014-307720.)
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Iron deficiency is one of the most common nutritional
deficiencies in children in developing countries and one way of
preventing it is fortification of the food. India also has Iron
fortified meal scheme. But all is well? Probably not! This is the
message we get by this study done in Kenyan children. In this study,
effect of high and low dose in-home iron fortification on the infant gut
microbiome and intestinal inflammation was studied. The primary outcome
was gut microbiome composition and secondary outcomes included fecal
calprotectin (marker of intestinal inflammation) and incidence of
diarrhea. It was found that iron-containing fortified food to weaning
infants adversely affected the gut microbiome, increasing pathogen
abundance and causing intestinal inflammation.
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