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Indian Pediatr 2012;49:163
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Gaurav Gupta
Email:
[email protected]
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Two days of dexamethasone versus 5 days of prednisone in the
treatment of acute asthma. (Ann Emerg Med. 2011; 58:
200-4)
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This randomized controlled trial compared the time
needed to return to normal activity and the frequency of relapse after
acute exacerbation of asthma in adults (18-45y) receiving either 5 days
of prednisone (50 mg daily) (n=96) or 2 days of dexamethasone (16
mg daily) (n=104). Return to normal activities within 3 days was
90% in dexamethasone group compared with 80% in the prednisone group (P=.049).
Relapse was similar between groups (13% versus 11%; P=.67).
Comment The study while done in adults discusses an important issue
faced by pediatrician. A 2 day course of dexamethasone would not only
increase compliance, but may produce also have the benefit of producing
less growth suppression in the pediatric population.
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Experience with levetiracetam for childhood refractory
epilepsy. (Arch Pediatr. 2012;19:3-8).
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This retrospective study was conducted to evaluate the efficacy
of levetiracetam as an adjuvant therapy in a population of 42
children (mean age 10.8 y; range 2.1-19 y) presenting with
drug-resistant epilepsy (mean duration 6.6 y; range 1.5-19 y),
over a 5-year-period. After the administration of levetiracetam,
10 patients (23.8%) became seizure-free and 16 (38.1%) had more
than 50% seizure reduction. A reduction of less than 50% was
observed in 13 patients (31%). Three patients (7.1%) had an
increase in seizure frequency. The effectiveness of
levetiracetam was similar in partial and generalized epilepsy.
Levetiracetam was well tolerated. This study confirmed the
effectiveness and tolerance of levetiracetam used as an adjuvant
therapy in children presenting with drug-resistant epilepsy.
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Prophylactic nevirapine to prevent mother-to-child HIV transmission
can be safely extended. (Lancet, Early Online Publication, 23
December 2011).
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Nevirapine given once-daily for the first 6, 14, or 28 weeks of life
to infants exposed to HIV-1 via breastfeeding reduces
transmission through this route compared with single-dose nevirapine at
birth or in neonatal period. In this phase 3, randomized, double-blind,
placebo-controlled HPTN 046 trial, the authors assessed the incremental
benefit of extension of once-daily infant nevirapine from age 6 weeks to
6 months. They enrolled breastfeeding infants born to mothers with HIV-1
in four African countries within 7 days of birth. Following receipt of
nevirapine from birth to 6 weeks, infants without HIV infection were
randomly allocated to receive extended nevirapine prophylaxis (n=762)
or placebo (n=765) until 6 months or until breastfeeding
cessation, whichever was earlier. The primary efficacy endpoint was
HIV-1 infection in infants at 6 months and safety endpoints were adverse
reactions in both groups. In Kaplan-Meier analysis, 1·1% (95% CI
0·3–1·8) of infants who received extended nevirapine developed HIV-1
between 6 weeks and 6 months compared with 2·4% (1·3–3·6) of controls
(difference 1·3%, 95% CI 0–2·6), equating to a 54% reduction in
transmission (P=0·049). However, mortality (1·2% for nevirapine vs 1·1%
for placebo; P=0·81) and combined HIV infection and mortality
rates (2·3% vs 3·2%; P=0·27) did not differ between groups
at 6 months. The frequency of adverse events, serious adverse events,
and deaths did not differ significantly between treatment groups.
Nevirapine prophylaxis can safely be used to provide protection from
mother-to-child transmission of HIV-1 via breastfeeding for infants up
to 6 months of age, and may further reduce risk of HIV transmission.
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H. Pylori in colorectal polyps now! (Pediatr Infect Dis
J. 2011 Dec 20).
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Seroprevalence of Helicobacter pylori was ascertained in
35 children, who had undergone polypectomy for colorectal
polyps. Another 27 children with gastrointestinal symptoms and
normal colonoscopy served as controls. H. pylori
infection was diagnosed if the serum urease antibody was
positive. The H. pylori positive rate in children with
colorectal polyps was 57.1% (20/35) compared to 22.2% (6/27) in
the control group (P<0.01). Age, gender, and the number,
size and locations of the colonic polyps were not significantly
different between children with H. pylori positive and
negative polyps. The H. pylori antibody-positive rate was
65.0% (13/20) in the patients with H. pylori
infection-positive colorectal polyps, which was higher than the
rate of 26.7% (4/15) for the patients with H. pylori
infection-negative colorectal polyps (P<0.05). These
findings suggest a positive association between H. pylori
infection and colorectal polyps in children.
Comment The theory of bacteria as a cause of disease has come
a full circle. From being derided as a cause of disease in the
19th century, to being accepted as a cause of infectious
diseases, and now as a part of many chronic "non-infectious
disease".
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