Urinary tract infections (UTIs) are a common source of bacterial infection among young febrile children. The diagnosis of UTI is challenging because the clinical presentation is not specific. This retrospective study analysed the clinical predictors to identify young children (<2 years) needing urine culture for evaluation of UTI. An incremental increase in risk for UTI is associated with younger age (younger than six months), having a white blood cell count higher than 15,000/mm3, parental report of malodorous or foul smelling urine and the absence of an alternative source of fever. In the present patient population, obtaining a urine culture from children with at least one of these clinical predictors would have resulted in missing one UTI (2%), and 111 negative cultures (20%) would have been avoided. Pediatr Child Health 2003; 8: 145

q  Adolescent obesity is fast becoming a public health problem. Can drugs be used to increase weight loss in obese adolescents? A Randomized, double-blind, placebo-controlled trial consisting of 82 adolescents with a body mass index (BMI) of 32 to 44 was undertaken using the drug sibutramine/placebo with behavioural therapy (BT). The addition of sibutramine to a comprehensive behavioral program induced significantly more weight loss than did BT and placebo. However the authors sound a note of caution stating that until further data is available this therapy would remain experimental in adolescents. JAMA 2003; 289: 1805

  Now it's Official! Alternative medicines (homeopathy in this case) have a role in acute childhood diarrhea. Three double blind clinical trials of diarrhea in 242 children ages 6 months to 5 years were analyzed as 1 group. Children were randomized to receive either an individualized homeopathic medicine or placebo to be taken as a single dose after each unformed stool for 5 days. Combined analysis showed a duration of diarrhea of 3.3 days in the homeopathy group compared with 4.1 in the placebo group (P = 0.008). The results from these studies confirm that individualized homeopathic treatment decreases the duration of acute childhood diarrhea. Homeopathy should be considered for use as an adjunct to oral rehydration for this illness. Pediatr Infect Dis J 2003; 22: 229

  Lamivudine is a potent inhibitor of hepatitis B virus (HBV) replication. This prospective open study reports the results of lamivudine treatment in children with chronic hepatitis B infection who did not respond to previous interferon treatment. Lamivudine, 3 mg/kg/day (maximum, 100 mg/day), was given for 52 weeks to 20 children and adolescents, ages 8.5 to 19 years, with chronic hepatitis B infection who had been treated with interferon 2 to 5 years earlier. The study concluded that children with chronic hepatitis B infection treated with lamivudine after failure of interferon therapy had decreased HBV replication and improved ALT values. However, lamivudine treatment resulted in an exceptionally high rate of lamivudine-resistant mutants and low HBeAg seroconversion rate. Pediatr Infect Dis J 2003; 22: 224

  In the era of fetal surgery, what is the role of expectant management of neonatal reflux? The current study was a long-term follow-up of prospective expectant management protocol for 31 patients with prenatal hydronephrosis and vesicoureteral reflux. Reflux resolved in 13 patients (52%) and improved in 6 (24%). Breakthrough urinary tract infection occurred in 4 patients with grades IV and V reflux, and dysfunctional voiding developed in 5. All patients had normal somatic growth at the 4-year followup and none had hypertension. The authors conclude that expectant management was effective in the majority of cases and associated with a low urinary tract infection rate. J Urol 2003; 169: 1837

  The appropriate duration of albendazole therapy in neurocysticercosis remains to be determined. To compare efficacy of 1 and 4 weeks of albendazole therapy in children with neurocysticercosis, a randomized, placebo-controlled, double blind clinical trial was conducted involving 122 consecutive children with seizures and 1-3 ring enhancing lesions on head computerized tomography (CT) examination. Albendazole therapy (15 mg/kg/day) was given for either 7 days (n = 60) or 4 weeks (n = 62). This trial suggests that 1 week of albendazole therapy was as effective as 4 weeks of therapy in children with neurocysticercosis having one to three lesions, with no significant differences in rate of resolution, reduction of size and number or seizure control. Pediatr Infect Dis J 2003; 22: 268

  How aggressively should we look for Gastroesophageal reflux (GER) in the pediatric asthma population? This study evaluated asthma outcome before and after anti-GER treatment in older children (age range, 5 to 10.5 years) who had persistent moderate asthma. Forty-six such consecutive children underwent extended esophageal pH monitoring. Of the 27 patients (59%) who had evidence of GER disease, 18 patients underwent medical treatment and 9 patients opted for surgical treatment. There was a significant reduction in the use of short- and long-acting bronchodilators as well as inhaled corticosteroids after anti-GER treatment was instituted in patients with GER disease (p <0.05). Thus, it would seem that anti-GER treatment in patients with GER disease and asthma results in a significant reduction in the requirement of asthma medications. Chest 2003; 123: 1008

C. Vidyashankar,
Pediatrician,
Military Hospital, Kamptee,
Nagpur 441001,
 Maharashtra,
India.
E-mail: [email protected]