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Gaurav Gupta
Email:
[email protected]
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Can diet during pregnancy affect risk of
life-threatening Respiratory Syncytial Virus infections in children?
(Am J Respir Crit Care Med; Feb 2013)
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The authors hypothesized that dietary preferences, differing from those
of our remote ancestors, would negatively impact children’s pulmonary
health. For instance, a diet rich in carbohydrates is a signature of
recent millennia and typical of low-income populations, heavily burdened
by life-threatening RSV disease. A prospective study in a catchment
population of 56,560 children<2 years old during the RSV season in
Argentina was done. All children with respiratory signs and
O2saturation<93% on admission were included. Among 1,293 children with
respiratory infections, 797(61.6%) were infected with RSV. 106 of these
had life-threatening disease. Twenty-two hospitalized children died (9
RSV+), 26 died at home due to ARI (14 attributed to RSV); all<12 months.
Life-threatening disease was dose-dependently associated with
carbohydrate ingestion during pregnancy [adjusted OR from 3.87 to 6.00].
It is concluded that diets rich in carbohydrates during pregnancy are
associated with severe outcomes in life-threatening and fatal RSV
infections.
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Division of tongue tie as an outpatient
procedure. Technique, efficacy and safety (Int J Pediatr
Otorhinolaryngol; Feb 2013)
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A retrospective study was undertaken to assess the clinical
presentations and the outcome of tongue tie division under local
anesthesia.63 infants had tongue tie division in the ENT outpatient
clinic under local anaesthesia between May 2010 and June 2011.
Preoperative symptoms and parents’ feedback were determined using
questionnaires based on NICE guidelines. Average age of the procedure
was 4.1 weeks. Before the procedure, 66.7% of babies had difficulty in
breast-feeding. 11.1% had poor growth. 22.2% had limitation in tongue
movement. 27.7% of the mothers had breast problems such as cracking and
soreness of the nipples. All the preoperative problems were resolved in
98.4%. 77.1% of parents’ comments were positive. They described
procedure as quick with minimal distress. 88.9% had no complications
following division of tongue tie. Tongue tie division is a simple
procedure with minimal complications. It can be undertaken under local
anesthesia within first 3 months of life in the outpatient environment.
Timely diagnosis, referral and treatment can make a difference in
breast-feeding and weight gain.
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Ondansetron in pregnancy and risk of adverse fetal outcomes
(NEJM; Feb 2013)
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Ondansetron is frequently used to treat nausea and vomiting during
pregnancy, but the safety of this drug for the fetus has not been well
studied. This study investigated the risk of adverse fetal outcomes
associated with ondansetron administered during pregnancy. From a
historical cohort of 608,385 pregnancies in Denmark, women who were
exposed to ondansetron and those who were not exposed were included, in
a 1:4 ratio, adjusted for hospitalization for nausea and vomiting during
pregnancy and the use of other antiemetics. Receipt of ondansetron was
not associated with a significantly increased risk of spontaneous
abortion, which occurred in 1.1% of exposed women and 3.7% of unexposed
women during gestational weeks 7 to 12, and in 1.0% and 2.1%,
respectively, during weeks 13 to 22 (hazard ratio, 0.60; 95% CI, 0.29 to
1.21). Ondansetron also conferred no significantly increased risk of
stillbirth, any major birth defect, preterm delivery, delivery of a
low-birth-weight infant, or delivery of a small-for-gestational-age
infant.
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Association of maternal vitamin D status
during pregnancy with bone-mineral content in offspring
(Lancet; Mar 2013)
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Eligible participants were 3960 mother-and-singleton-offspring pairs in
which the mother had recorded measurements of 25(OH)D concentration in
pregnancy and the offspring had undergone dual-energy x-ray
absorptiometry at age 9-10 years. Associations between maternal serum
25(OH)D concentrations and offspring total body less head (TBLH) and
spinal BMC were assessed by trimester. Mean offspring age was 9·9 years.
2644 (77%) mothers had sufficient, 1096 (28%) insufficient, and 220 (6%)
deficient 25(OH)D concentrations in pregnancy, but TBLH and spinal BMC
did not differ between offspring of mothers in the lower two groups
versus sufficient 25(OH)D concentration. The authors concluded that
there was no association between maternal vitamin D status in pregnancy
and offspring BMC in late childhood.
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Association between GBS and the Pandemic H1N1 monovalent
vaccine (Lancet; Mar 2013)
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The authors did a meta-analysis of data from the adverse event
monitoring project to ascertain whether influenza A (H1N1) 2009
monovalent inactivated vaccines used in the USA increased the risk of
Guillain-Barré syndrome. About 23 million vaccinated people were
included in the analysis. The primary analysis entailed calculation of
incidence rate ratios and attributable risks of excess cases of
Guillain-Barré syndrome per million vaccinations. Influenza A (H1N1)
2009 monovalent inactivated vaccines were associated with a small
increased risk of Guillain-Barré syndrome (incidence rate ratio 2·35,
95% CI 1·42-4·01, P=0·0003). This finding translated to about 1·6
excess cases of Guillain-Barré syndrome per million people vaccinated.
The modest risk of Guillain-Barré syndrome attributed to vaccination is
consistent with previous estimates of the disorder after seasonal
influenza vaccination.
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