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Indian Pediatr 2012;49: 686
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Gaurav Gupta
[email protected]
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Neonatal circumcision – complications and preventive effect on UTI
(J Ped Urol 2012;8:320)
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To evaluate the preventive effect of neonatal circumcision on urinary
tract infection and the incidence of complications following neonatal
circumcision, a prospective study was carried out between 2004 and 2008.
During this period, there were 3000 neonatal circumcisions. All cases
were examined for any complications 1 week later, and occurrence of
meatal stenosis was followed up to 15 months of age. In this group,
urine analysis and culture was successfully performed four times for
2000 circumcised infants at 1.5, 3, 9 and 15 months. In the control
group of 3000 uncircumcised infants, 1000 cases accomplished urine
analysis and culture at the same designated intervals. A positive urine
culture was observed in none of the circumcised cases and in 20 (2%)
uncircumcised cases after obtaining a suprapubic bladder aspiration
sample. The latter 20 infants were circumcised and follow-up cultures
were negative in 17 cases. The overall complication rate in the
circumcised group was 1.6%. The difference in frequency of urinary tract
infection between the two groups was statistically significant (P<0.001).
Neonatal circumcision has few complications and reduces the incidence of
asymptomatic urinary infection. It may be considered as a preventive
health measure.
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Procalcitonin for predicting acute pyelonephritis in febrile
UTI (Emerg Med J doi:10.1136/emermed-2011-2008)
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Urinary tract infection (UTI) is a common bacterial infection in
children that can result in permanent renal damage. This study
prospectively assessed the diagnostic performance of
procalcitonin (PCT) for predicting acute pyelonephritis among
children aged <10years with febrile UTI presenting to the
pediatric emergency department. The 136 enrolled patients (56
boys and 80 girls; age range 1month to 10 years) were divided
into acute pyelonephritis (n=87) and lower UTI (n=49)
groups according to 99mTc-dimercaptosuccinic acid scan results.
The cut-off value for maximum diagnostic performance of PCT was
1.3 ng/mL (sensitivity 86.2%; specificity 89.8%). By
multivariate regression analysis, only procalcitonin and CRP
were retained as significant predictors of acute pyelonephritis.
PCT has better sensitivity and specificity than CRP and WBC
count for distinguishing between pyelonephritis and lower UTI.
However, the cost of the test, and the turnaround time of our
labs needs to be kept in mind before implementing this routinely
in our setting.
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Preterm nursery weight gain better with intermittent darkness (J
Pediatr 2012;140:192)
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The purpose was to evaluate the benefits of cycled light (CL) versus
near darkness (ND) on health in preterm infants born at <31 weeks’
gestational age. A randomized, interventional study comparing infants
receiving (1) CL from birth, (2) CL at 32 weeks post-conceptional age
(PCA), and (3) CL at 36 weeks PCA in transition for discharge home.
Infants receiving CL at birth and 32 weeks gained weight faster than
infants not receiving CL until 36 weeks PCA. There were no differences
among the groups in length of hospitalization stay or number of
ventilator days, but the power was low for these variables. These
findings suggest that CL has significant weight gain benefits over ND,
and there are no short-term advantages of ND over cycled light for
health in preterm infants.
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And now probiotics for treating perennial allergic rhinitis (Int
J Pediatr Otorhinolaryngol. 2012;76:994-1001)
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Supplementary consumption of probiotics may temporarily alter the
intestinal microflora of infants and children, thereby preventing and
treating allergic disorders. This study compared the clinical efficacy
of levocetirizine with that of levocetirizine plus Lactobacillus
johnsonii EM1 (Lj EM1) for treating perennial allergic rhinitis
(PAR) in children. Sixty-three children aged 7-12 years fulfilled the
entry criteria for the study and had moderate to severe PAR of at least
1 year duration. The treatment followed a randomized, open-label
crossover design: all subjects were randomized to 2 crossover treatment
regimens of levocetirizine with Lj EM1 (group 1) or levocetirizine alone
(group 2) for 12 weeks; subsequently, treatments were reversed for a
further 12 weeks. The effects of the 2 regimens were compared using the
Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) and
the total symptom score (TSS) from diary cards. After the first 12 weeks
of treatment, both groups had improved TSS at weeks 4, 8, and 12 (P<0.05),
and group 1 was more efficacious than group 2 at week 4 (P=0.014),
week 8 (P=0.011), and week 12 (P<0.009). During the second
12-week period, group 2 showed continual and progressive improvement,
while group 1 did not. The PRQLQ scores were significantly decreased in
both groups (P<0.05), but there was no statistically significant
difference between the 2 groups (P=0.446). No serious adverse
events were recorded in either treatment group. The 24-week, 2-phase,
crossover treatment program showed that levocetirizine plus Lj EM1 was
more effective for PAR than levocetirizine and that this difference
persisted for at least 3 months after discontinuation of Lj EM1.
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