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Clippings Indian Pediatrics 2002; 39:222-225 |
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A study from Vietnam has suggested that combination of antimalarials may be required to combat resistant falciparum malaria. This study compared the effectiveness of artesunate(4 mg/kg on day 0 and 2 mg/kg on days 1-4) and mefloquine(15 mg/kg) on 41 children and 21 adults with uncomplicated falciparum malaria. The researchers observed that 15 of the 41 children had recrudescence or re-infection with 29% showing resistance to artesunate and 23% to mefloquine.The researchers also noted that recurrence was linked to the level of parasitemia. The study concluded that in hyperendemic areas a combination of antimalarials like mefloquine plus artesunate may be needed. They also recommended that in view of drug resistance a higher dose(25 mg/kg) of mefloquine may be necessary.(Ann of Trop Pediatr 2001; 21: 307-312) Exposure to pollution in the first trimester of pregnancy has been found linked to congenital heart disease. A study from California came to this conclusion after comparing 600 children with birth defects and over 9000 healthy controls. The study observed that exposure to urban smug was associated with increased incidence of ventricular septal defects, conotruncal defects, aortic and pulomonary valvular defects. The researchers noted that high levels of carbon monxide, ozone and certain other chemicals present in automobile emissions may be responsible for the teratogenic effects on the growing embryo. They however noted no link between exposure to pollution and cleft palate.(Am J Epidemiol 2002;155). Eating disorders having their onset in late childhood and adolescence may persist in adult life also, reports a study from New York. Of the eight hundred children who were followed up for 17 years, eating disorders were present in less than 3%. The researchers observed that adolescents with bulimia were over twenty times more likely to have bulimia as adults. Similarly children who were difficult eaters were more likely to suffer from anorexia as young adults. The study concludes by recommending close monitoring and early treatment of childhood eating disorders. (J Am Acad Child and Adol Psychiatr 2001; 40: 1434-1440.) Recurrent infection with Group A beta hemolytic streptococcus in children has been found linked to psychiatric disorders like obsessive compulsive disorder and move- ment disorders like Tourette’s syndrome. Researchers from USA made these observa-tions based on presence of psychiatric manifestations in 25 children who had streptococcal sore throat infections. The study noted that both the infection and psychiatric symptoms subsided with antibiotic therapy. Recurrence of the psychiatric symptoms in six children also responded to antibiotic therapy. The researchers proposed that recurrent streptococcal infection can result in neurologic damage which can lead to these psychiatric disorders also classified as PANDAS (pediatric onset neuropsychiatric disorder) and recommended early treatment of streptococcal infections. (from Reutershealth, Oct 19, 2001; Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, Oct 2001). Ocular damage has been reported with the use of vigabantrin, a newer anticonvul-sant.This study evaluated the eye changes in 21 children with difficult-to-treat seizures includ-ing West syndrome and Lennox-Gastaut syndrome who had received vigabantrin for a mean duration of around 3 years. The researchers noted changes in the retina in the form of vascular sheathing, optic atrophy and pigmentary changes in 4 (19%) of the children, while visual evoked potentials were abnormal in over 75% of the children. The researchers advised ophthalmologic evaluation including visual evoked potentials and electroretino-graphy at 3- 6 months intervals for early detection of these changes and modification of treatment.(Arch Dis Child 2001; 85: 469-473). An intradermal skin test has been found accurate in evaluating immunity status to varicella. This study from Israel compared a skin test based on OKA virus strain with a serum antibody assay using indirect fluorescent antibody assay. Of the 61 children tested using both the methods, 41 tested positive with the skin test while 43 showed a positive antibody titer. In comparison with the serological test, the intradermal test showed a sensitivity and specificity of 95% and a positive and negative predictive value of over 90%. The study concluded that the skin test is effective in assessing status of immunity to varicella zoster virus. (Arch Dis Child 2001; 85: 484-486). Murmurs that persist after the closure of patent ductus may be due to transient pulmonary artery branch stenosis, suggests a study from Znrich, Switzerland. The study followed up 50 preterm neonates born at less than 32 weeks gestation who were detected to have PDA. The researchers noted the appearance of pulmonary branch stenosis in 59% of these neonates after the closure of the PDA. The left branch was predominantly involved in three fourth of the infants, while both the branches were involved in 21%. The pulmonary branch stenosis subsided spontaneously in nearly 75% of the infants by 40 weeks and in all the infants by 3 months of corrected age. The researchers concluded that persistence of murmur of PDA can be due to pulmonary artery branch stenosis rather than re-opening of the patent ductus arteriosus. (Arch Dis Child Fetal Neonatal Ed 2001; 85: F197-F200 ). The relationship between pre-eclampsia and neonatal encephalopathy has been re-enforced by this study from UK. The researchers who observed the obstetric outcome in over 600 pregnancies reported that pre-eclampsia had a significant association with neonatal ence-phalopathy, low cord blood pH and maternal fever. The odds ratio for neonatal ence-phalopathy was 25.5 and the risk was inde-pendent of cord blood acidosis and maternal fever.The researchers concluded that an inflammatory reaction that occurs as a consequence of pre-eclampsia resulting in decreased cerebral blood flow, may be the causative factor for neonatal encephalopathy. (Arch Dis Child Fetal Neonatal Ed 2001; 85: F170-F172). Extreme low birth weight infants are more likely to develop disabilities in the long term. A 14-year follow up of 351 infants born with weights between 500-999 grams, reported a survival of 88(25%) of whom 79 were followed up till 14 years. The researchers observed disabilities in over 50% with severe disabilities noted in 14%. Ten percent had cerebral palsy while 46% had a lower IQ as compared with the controls. The researchers also noted blindness in 6% and hearing deficit in 5%. The researchers recommended screening for disabilities at an early age. Another study, this time from Denmark concluded that the objective quality of life of 92 young adults who were born with very low birth weights was lower as compared with 119 controls. (Arch Dis Child Fetal Neonatal Ed 2001; 85: F159-F164, F 165-169). A study on the role of thrombosis in hemolytic-uremic syndrome due to Escheri-chia coli O157:H7 infection evaluated the coagulation and renal function in 53 children infected with Escherichia coli O157:H7. The initial evaluation was done within four days of E. coli infection. The parameters were again measured in 16 children who went on to develop hemolytic syndrome. The researchers observed that the initial plasma concentra-tions of prothrombin fragment 1+2, tissue plasminogen activator (t-PA) antigen, t-PA-plasminogen-activator inhibitor type 1 (PAI-1) complex, and D-dimer were significantly higher among those children who subsequent-ly developed hemolytic-uremic syndrome. Their levels increased further before the onset of uremia and other features of hemolytic-uremic syndrome, the study noted. The researchers thus concluded that the thrombotic abnormalities occur before the renal complications and may have a role in early detection and treatment of hemolytic-uremic syndrome.Based on these findings, a related editorial recommends further research on the role of prophylactic anti-thrombotic agents in preventing hemolytic-uremic syndrome. (N Eng J Med 2002; 346: 23-32, 58-61). Abciximab, a platelet glycoprotein IIb/IIIa receptor inhibitor has been found to have a role in regression of coronary aneurysms due to Kawasaki’s disease. In this study on fifteen patients with Kawasaki’s disease, nine patients received the standard regimen, while six received abciximab, in addition to the standard regimen. The researchers observed that 68% of the aneurysms regressed in the abciximab group as compared to 35% in the controls. While recommending further studies, the researchers concluded that Abciximab may have a role in management of Kawasaki’s disease. (Pediatrics 2002; 109: e4). A study from Spain has reported that Helium-oxygen (heliox) therapy has been found beneficial in treatment of bronchiolitis. The researchers made these observations from a study on 38 children with moderate- severe bronchiolitis who received either heliox: containing 70% helium and 30% oxygen through a face mask or nebulized epineph- rine. The researchers noticed a significant improvement in the clinical parameters, pulse oximetry and end-tidal CO2 in the heliox group as compared to the controls. Heliox was administered for a mean duration of 53 hours in the study group with a shorter duration of hospitalisation and no significant side effects. The researchers concluded that Heliox may have a role in treatment of moderate and severe bronchiolitis.(Pediatrics 2002; 109: 68-73) While zinc supplements may prevent and reduce severity of infections, its role in promoting growth has been questioned by this study from Bangladesh.In this study, over 600 children between 1 and 3 years received either oral zinc, vitamin A, a combination of zinc and vitamin A or a placebo for 6 months. The researchers observed that there was no significant difference in weight and height of the children in the four groups. (American Journal of Clinical Nutrition 2002; 75: 87-91). However, the researchers noted that zinc supplements when given with vitamin A significantly improved the vitamin A status in vitamin A deficient children.(Amer J Clin Nutr 2002; 75:92-98). Do children with diabetes mellitus have learning deficits? This multicentric study evaluated 244 children with IDDM having a mean age of around 14 years. Academic achievements and behavioral assessment were carried out in these children and sibling controls. The study noted that though there was no difference in the academic skills between the diabetics and controls; increased school absences and behavioural problems like mood variability was more common among the diabetics. They also noted that among the diabetic children, those with poor glycemic control had lower academic performance as compared with children with a good control.The researchers however cautioned that care should be taken to prevent hypoglycemia because repeated episodes can produce both learning and cognitive deficits. (Pediatrics 2002; 109:e9). C. Vidyashankar, |
