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Indian Pediatrics 2002; 39:611-612

Statistical analysis made easy

There’s more news on link between streptococcal sore throat and transient psychiatric illness or PANDAS. (Pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal infection). Researchers from New York have reported 12 cases over a 2-year period with transient obsessive-compulsive disorder and attention-deficit/hyperactivity disorder following streptococcal pharyngitis. The symptoms regressed with treatment and recurred with further episodes of streptococcal pharyngitis, they note. The researchers attribute this to streptococcal toxin, rather than the autoimmune process involved in rheumatic chorea. Children with acute onset behavioral disorders may need to be screened for this condition, they conclude (Arch Pediatr Adolesc Med 2002:156:356-361).

Botulinum toxin may provide relief to children with neurogenic bladder! In this study from Germany, botulinum toxin was cystoscopically injected in the bladder wall of 17 children with detrusor hyperreflexia due to myelomeningocele. The treatment resulted in a reduction in the detrusor pressure, improvement in detrusor compliance and symptomatic relief, the researchers observed. While recommending further studies, the researchers conclude that botulinum toxin improves bladder capacity and provides symptomatic relief in neurogenic bladder (Urology 2002;59:325-328).

According to British researchers, Procalcitonin is a better diagnostic marker for meningococcal infections as compared to CRP. The study, conducted on 64 children with meningococcal infections and 44 controls observed that procalcitonin levels greater than 2ng/ml had a sensitivity of 94% and specificity of 93% in diagnosis of meningococcal infections. It is better than total leukocyte count and C reactive protein, the researchers conclude (Arch Dis Child 2002;86:282-285).

Stereotactic surgery for intractable seizures has been made simpler with the use of gamma knife. Researchers from Florida, USA have used this method with some success on four children with intractable seizures. Hypothalamic hamartomas were the cause of seizures in two and neurocortical epilepsy in the other two children. The researchers report a significant reduction in seizures in three of their four patients. They conclude that gamma knife is useful option for intractable seizures caused by lesions otherwise considered inoperable (Epilepsy 2002; 43:292-300).

Secondary bacterial infections are uncommon following Respiratory syncitial vivel infections(RSV), a retrospective study states. The researchers analyzed records of over 2000 children admitted with RSV bronchiolitis and pneumonia over a 7-year period. They observed that that the mean duration of hospitalization was 5 days and that only around 1% developed secondary bacterial infections. Hence, in a setting of children admitted with classical signs and symptoms and a positive rapid antigen test for RSV, antibiotics are not indicated, the researchers conclude (Arch Pediatr Adolesc Med 2002;156: 322-324).

Evidence based medicine says that IV magnesium sulfate can benefit children with severe and life threatening asthma. Of the four studies that were analyzed, three reported a reduction in duration of hospitalization in children with severe asthma. Significant side effects were not noted in any of the studies. Considering its safety, low cost and effectiveness, intravenous magnesium sulfate may have a role in severe and life threatening asthma, the study concluded (Arch Dis Child 2002; 86:381-382).

Measles can lead to a transient inhibition of HIV virus multiplication! Researchers from the Johns Hopkins University in Baltimore have made this observation after a study on 89 HIV positive children admitted with measles. The researchers noted that the median HIV RNA levels were 5339 copies/ml at the time of admission and 60,121 copies/ml at discharge. The levels in controls were significantly higher at over 300,000 copies/ml. The inhibition of HIV virus could be due to higher levels of Interleukin, they hypothesize. However, the inhibition is only transient and the replication gets accelerated following recovery from measles, they conclude (J Infect Dis 2002;185:1035-1042).

Antenatal exposure to anti-convulsants may lead to developmental delay in offspring, researchers from the UK report. In this study, the developmental status of 293 children born to149 mothers who were on mainly valporate and carbamazepine, was assessed. The researchers noted that a delay in speech and gross motor function was over twice as common in those antenatally exposed to anti-convulsants. A related editorial states that while anti-convulsants should be continued during pregnancy, the possible side effects should be explained to patients. Use of newer anti-convulsants, which are relatively safer in pregnancy may be safer, they conclude (Medical Genetics 2002;39:251-259,248-249).

Urinary tract infections may present as jaundice in young infants! Researchers from California made this observation on evaluation of 160 infants less than 8 weeks of age with asymptomatic jaundice. The researchers noted that 12(7.5%) had a urinary tract infection with abnormal urinalysis, culture or renal ultrasound findings. Conjugated hyper-bilirubinemia was present in all these infants. The study concludes that UTI should be considered in the differential diagnosis in infants presenting with jaundice (Pediatrics 2002; 109: 846-851).

There is a significant risk of adult-child spread of MDR tuberculosis. This study from South Africa followed up 125 children who were in contact with 73 MDR TB adults. In a 30-month follow up, the researchers noted that 54% showed signs of TB infection, while 24% developed the disease. DNA fingerprinting revealed the adult strain in three of four cases carried out. Of the 41 children who received chemoprophylaxis, only two developed the disease. The risk of adult-child transmission is significant and can be prevented with chemoprophylaxis, the study concludes (Pediatrics 2002; 109: 765-771).

Zinc supplements given during the episode can shorten the duration of diarrhea. In this multinational study from Nepal, over 1700 children with acute diarrhea received either zinc syrup containing 3 RDA of zinc, zinc and Vitamin A or a placebo. Over 43% reduction in the risk of prolonged diarrhea and a significant decrease in vomiting were noted in the zinc-supplemented group. These benefits were not seen in the zinc and vitamin A group, the researchers note. The researchers concluded that zinc supplements have a role in treatment of acute diarrhea (Pediatrics 2002; 109: 898-903).

C Vidyashankar,

Email:[email protected].