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Indian Pediatr 2015;52: 722
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Gaurav Gupta
Email:
[email protected]
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Eye examination can predict severity of cerebral malaria (J
Infect Dis. 2015;211:1977)
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Malarial retinopathy has diagnostic and prognostic value in children
with P. falciparum cerebral malaria. A clinicopathological
correlation between observed retinal changes during life and the degree
of sequestration of parasitized red blood cells was investigated in
ocular and cerebral vessels at autopsy in 18 Malawian children who died
from clinically defined cerebral malaria. The authors studied the
intensity of sequestration and the maturity of sequestered parasites in
the retina, in nonretinal ocular tissues, and in the brain. Five
children with clinically defined cerebral malaria during life had other
causes of death identified at autopsy; no malarial retinopathy and
scanty intracerebral sequestration was seen in them. Thirteen children
had malarial retinopathy; severity correlated with percentage of
microvessels parasitized in the retina, brain, and nonretinal tissues
with some neuroectodermal components. In moderate/severe cases of
retinopathy (n=8), vascular congestion was more intense,
sequestered parasites were more mature, and the quantity of
extraerythrocytic hemozoin was higher in comparison to those with mild
retinopathy (n=5). These data provide a histopathological basis
for the known correlation between degrees of retinopathy and cerebral
dysfunction in cerebral malaria. In addition to being a valuable tool
for clinical diagnosis, retinal observations give important information
about neurovascular pathophysiology of cerebral malaria in children.
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Does vitamin D status in early life affect risk of allergies
in childhood? (J Allergy Clin Immunol.
2015:DOI: http://dx.doi.org/10.1016/j.jaci.2015.04.017)
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The study sought to examine the associations between early-life vitamin
D levels and the development of allergy-related outcomes in a racially
diverse longitudinal birth cohort. 25-hydroxyvitamin D [25(OH)D] levels
were measured in stored blood samples from pregnancy, cord blood, and
age 2 years. Logistic regression models were used to calculate odds
ratios (ORs) for a 5 ng/mL increase in 25(OH)D levels for the following
outcomes at age 2 years: eczema, skin prick tests (SPTs), increased
allergen-specific IgE level ( >0.35 IU/mL) and doctor’s diagnosis of
asthma (3-6 years). Prenatal 25(OH)D levels were inversely associated
with eczema. The association was stronger in white children, although
this was not statistically significant. Cord blood 25(OH)D levels were
inversely associated with having one or more positive SPT responses and
aeroallergen sensitization. Both associations were statistically
significant in white children in contrast with black children. 25(OH)D
levels measured concurrently with outcome assessment were inversely
associated with aeroallergen sensitization only among black children.
Prenatal and cord blood 25(OH)D levels were associated with some
allergy-related outcomes, with a general pattern indicating that
children with higher 25(OH)D levels tend to have fewer allergy-related
outcomes.
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Do multiple doses of flu vaccine increase local reactions?
(Vaccine. 2015;33:3586)
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In order to assess factors associated with reactogenicity of trivalent
inactivated influenza vaccine (IIV3) among young children, data on 1538
vaccinees aged 0-5 years in a previous vaccine effectiveness study were
analyzed. The most frequent reaction was redness (19%), followed by
induration, swelling, itching, and pain (6-12%); there were no serious
adverse events. For some local reactions, multivariate analyses
indicated associations of younger age, preschool attendance, presence of
siblings and allergy with lower risk, and use of thinner needles with
higher risk. Administration of one or more IIV3 vaccines during the
previous three seasons was positively associated with each local
reaction (adjusted OR 3.6,5.4). For subjects aged e3 years, prior
successive annual vaccinations were associated with substantially
increased local reactions, with clear dose-response relationships; for
example, a 9.8-fold greater risk of swelling following three successive
annual vaccinations before the study season.
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Blood in stools of healthy infants – Milk maybe the key!
(J Pediatr Gastroenterol Nutr. 2015;61:69)
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The dietary protein proctocolitis, also known as allergic proctocolitis,
is characterized by the presence of mucoid, frothy and bloody stools in
an otherwise healthy infant. The aim of this study was to describe a
group of children with allergic proctocolitis, diagnosed according to
the criterion-standard method, food challenge, to provide clinicians
with more information on typical presentation, and an overview on
nutritional management strategies and prognosis. The authors collected
data on infants with allergic proctocolitis in outpatient clinics. Other
conditions that may cause bloody diarrhea were ruled out. Skin prick
tests and atopy patch tests were performed for diagnosis, and patients
were studied for resolution. For the patients whose rectal bleeding did
not recover with oligoantigenic maternal diet in addition to amino
acid-based formula, endoscopic evaluation was performed to confirm the
diagnosis and to exclude other reasons of rectal bleeding. Sixty
patients were diagnosed as having allergic proctocolitis. The mean (SD)
age of onset was 1.7 (1.32) months. In all of the patients, symptoms
were triggered by milk, 6.6% with milk and egg, 3.3% with milk and
chicken, 1.7% with milk and wheat, and 1.7% with milk and potato; 3.3%
had multiple food allergy. Thirty-two (53.3%) patients acquired
tolerance by age of 1 year, 25% (n=15) by 2 years, 5% (n
=3) by 3 years, and in one patient by the age of 4 years.
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