Global Update |
| News in Brief Cancer epidemic: In April 1986, several million curies of radioactive material including radioactive iodine were scattered over Russia, Ukraine and Belarus in the 10 days which followed the nuclear disaster in Chernobyl. Milk from cows who ate the contaminated grass presumably transferred the radioactive iodine to children. The underlying iodine deficiency coupled with the exquisite sensitivity of pediatric thyroid tissue to radiation completes the final link of the story. Now there are only dismaying statistics to survey. From 59 cases of thyroid cancers in children in 1981-85 the number has risen to 577 between 1985-97. The annual incidence between 1981-85 was 12 and rose to 73 in 1996-97. The worst affected were children who were under five in 1986, though adolescents have also not been spared. Mainly pappilary cell carcinomas have been reported and most children have required surgery. Perhaps Chernobyl has been one of the greatest preventable tragedies of the century (Lancet July 10, 1999). The old order changeth: Is the Director of the National Insittue of Health, USA, performing the last rites of the printed journal as we know it? His statement that the Ebiomed will provide "free, fast and full access to the entire biomedical literature" has sent shock waves through editorial offices in the world. In clarifications of the statement he has upheld the importance of rigourous review and copy editing but many drastic changes seem imminent. Articles will be posted online immediately on acceptance and the concept of peer review will under go a sea change. The success of the plan depends on the consent of major prestigious journals to be swallowed up into Ebiomed. Funding is also another major consideration. But no one is denying that there is a revolution afoot and excitement in the air (BMJ 10 July, 1999). Futuristics Touch and go: What is feeling? What makes up the gamut of sensations we call touch? Scientists in the field of haptics struggle for the answers. Haptikos is greek for "able to touch". For advances in prosthesis and tele-surgery, haptics is the happening science. First they study the components of touch both at the skin level and at the joints and tendons. Then is to perfect the currently crude art of mimicking it by a computer using virtual reality. Finally, the crucial element would be to find the appropriate substance to form an interface between electronic and biological systems which could transfer information from objects to computers and from computers to neurons. Researchers feel porous silicon may well fit the bill. If all works well a new generation of prosthesis awaits us (Lancet 3 July, 1999). Policy Grading Hospitals: After the hullabaloo over the unacceptable mortality rates of pediatric cardiac surgery in Bristol, even the naturally reticent British are opening up. The Department of Health in England has just published the results of a 2 year study on the comparitive performance of various hospitals using a set of clinical indicators such as mortality after common surgeries. It gives an overall assessment of the work done in a hospital and not of individuals as in USA. It's purported aim is to pick up grossly aberrant clinical standards as an early warning system and not to encourage patients to shop around. It has not accounted for severity of illnesses in particular hospitals but hospitals have been grouped according to size. Quality control is inevitable with an increasingly knowledgable public (Lancet 26 June, 99). People Watch A man in a hurry: Craig Venter says he will sequence the entire human genome by 2001. His monthly output of genetic sequences will exceed all the sequences generated by the Human Genome Project so far. The Institute for Genetic Research (TIGR) set up by him was the first to sequence the entire genome of an organism (H. influenzae) and has done it again with 11 more free living organisms. His life has been colorful to say the least. From a school boy who refused exams, scraped through high school and passed time as a beach bum in california he was rudely awakened when he was sent to Vietnam. The grim realities of life and death and advise from a dermatologist friend led him towards medicine. But his heart was in research. In the Human Genome Project in the NIH his proposal for a new technique to sequence genomes fast was rejected and resulted in the birth of TIGR. He plans to make the genetic sequences he unravels, freely available on his Celera web site though subscriptions to the site will cost money (Lancet 26, June 99). The British Medical Association wants to lobby for a legislation in which all patients who die will be presumed to have given consent for donation. Gouri Rao Passi, Associate Consultant, |
| Thimerosal in Vaccines On 7 July 1999, the American Academy of Pediatrics (AAP) and the U.S. Public Health Service (PHS) issued a joint statement regarding vaccines containing thiomerosal, an organic mercury based preservative. This follows a review of the risk of all mercury containing foods and drugs by the U.S. Food and Drug Administration (FDA) in 1999. Thimerosal is an organic mercury compound which in high doses can cause toxicity, especially of the nervous system. Several vaccines contain Thimerosal as a preservative. The joint statement cautions that some children could be exposed to a cumulative level of mercury over the first six months of age that exceed one of the federal guidelines on methyl mercury. However, there are no data or evidence of any harm caused by the level of exposure following immunization in children, as there is a significant safety margin. And the risks in not immunizing children far outweigh the unknown and probably smaller risk of this exposure. Nevertheless, the statement agrees that Thimerosal containing vaccines should be removed as soon as possible and has requested the manufacturers for a clear commitment. The statement advises pediatricians to continue the same immunization schedule as currently recommended by the AAP. The only suggested change is to postpone Hepatitis B immunization for newborns born to mothers who are negative for HbsAg. The statement advises to start this at six months of age instead of at birth. For those children whose mothers are HbsAg positive or status unknown, the statement recommends to continue the current practice of starting immunization at birth. There is no need to test the blood, urine or hair of children who received these vaccines and who may be at risk. The statement also recommends discussing with the parents the benefits and risks of immunizing children with vaccines containing Thimerosal. Alexander Mathew, Department of Pediatrics, |
| Pedscapes Zero to Three - http://www.zerotothree. org/. Zero to Three is a national, nonprofit organization located in Washington, D.C., dedicated solely to advancing the healthy development of babies and young children. This organization disseminates key developmental information, trains providers, promotes model approaches and standards of practice and works to increase public awareness about the significance of the first three years of life. This website contains information on various developmental issues in pediatrics, both for the doctor and the patient. Emerging Infectious Diseases (CDC) - http://www.cdc.gov/ncidod/EID/eid.htm. Emerginging Infectious Diseases is published 4 to 6 times a year by the National Center for Infectious Diseases, Centers for Disease Control. Emerging Infectious Diseases is peer reviewed and provides information on all aspects of emerging infections. It summarizes existing information on specific emerging diseases or syndromes; reports preliminary but promising laboratory or epidemiologic data and public health policies based on research and analysis of emerging disease issues. The full text of this journal is online an is free. Pediatric Research - http://www.wwilkins. com/PDR/0031-3998toc.html. Published monthly, this is the journal of American Pediatric Society, European Society for Pediatric Research and Society for Pediatric Research. Abstracts from this are accessible from the site. This journal deals with basic research in Pediatrics. Electronic Textbook of Statistics - http://www.statsoft.com/textbook/stathome.html. Everything about statistics is given here, starting from basics and gradually progressing to advanced concepts. The site is well illustrated with examples. The complete Electronics Statistics Textbook can be downloaded for quick access. Directions for correctly installing the textbook are also available online. Perioperative Fluid Management - http://gasnet.med.yale.edu/gta/fluids.html. This is a multimedia tutorial on perioperative fluid therapy in pediatrics, which is an important aspect of Pediatric Anesthesia. The material for this site has been contributed by the Department of Anesthesiology, Goethe University, Frankfurt. Medline Comparison Table - http://www.medmatrix.org/info/medlinetable.asp. Many sites offer free medline access. A comparison of the various features of each of these sites is given here. The information is given in a tabular form, for easy reading. Though each of these has something unique, the Pubmed site (www.ncbi.nlm.nih.gov/pubmed/) is the best mainly because of its speed of access and the fact that no registration is required. Those accessing this site for the first time should go to www.medmatrix.org and register before using above address. Pedbase - http://www.icondata.com/health/pedbase/pedlynx.htm. A large collection of over 500 disorders in Pediatrics is presented here. This is in the form of a textbook. The diseases covered are mainly genetic and metabolic disorders using major textbooks as references. However, the information is mainly text based with very few images. A pediatrician from USA has developed this site. Being a shareware, it is possible to access the entire Database. Pediatric Pulmonology - www.pedi-resp-pulm.com. This has information on various topics on pediatric pulmonology. The Children's Hospital Oakland hosts this site. Case presentations, links to various sources on pediatric pulmonology, including those of sites offering audio of lung sounds are also available here. Food, Nutrition and Balanced Diet - http://www.geocities.com/HotSprings/Bath/2191/. This site, hosted by a Pediatrician from Lucknow, contains information on Nutrition and diets for all age groups. It is based on the recommendations of Indian Council of Medical Research. It includes nutritives values of various foods and diets for various age groups. The sections on weaning and infant feeding are of pediatric interest. Hydrocephalus - http://www.ninds.nih.gov/healinfo/DISORDER/hydrochd /HYDROCHD.HTM. This site, from the National institute of Neurological diseases, a part of the National Institutes of Health, USA deals with various aspects of hydrocephalus including etiology, diagnosis, treatment and information about recent research in this field. The information presented is recent and updated, but with only a few images. C. Vidyashankar, |
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