• Protection of Health Care Workers from Hepatitis B infection may require more than one series of immunization to achieve protective antibody levels. A study from Japan analysing anti-HBs levels in healthcare workers over 10 years following booster vaccination for hepatitis B virus revealed that the additional three-dose protocol of booster HBsAg vaccination is beneficial in main taining a seroprotective level of anti-HBs. A total of 104 Japanese healthcare workers who received three booster HBV surface antigen (HBsAg) vaccines were included in the study because 80 became anti-HBs-negative at a mean of 2.4 years after the primary vaccination and 24 did not respond to primary vaccination. Of the re-vaccinees, 96% achieved a level of 10 mIU/ml or more of anti-HBs (i.e. seroprotected), 1 month after booster vaccination. Although anti-HBs levels of re-vaccinees decreased as rapidly as those of primary immunized vaccinees, at 10 years post-booster, 64% of re-vaccinees maintained anti-HBs levels at 10 mIU/ml or higher. (Vaccine 2003; 21: 3789-3794)

• The role of 'immunonutrients' for enhancing the immune function has been extensively studied. A systematic review of all the randomised clinical trials pertaining to Immunonutrition in critically ill patients was done, using 4 patient groups - surgical, trauma, burn or medical. The incidence of infectious complications and other outcome variables like days on mechanical ventilation, length of ICU and hospital stay, mortality etc. were evaluated. There was a reduction in infection rate in the pharmaconutrition group, having lower incidence of abdominal abscesses, nosocomial pneumonia and bacteremia. Also patients treated with pharmaconutrition diets had a reduction in time on mechanical ventilation, ICU and hospital length of stay. However, there was no effect on overall mortality. A separate analysis for each subgroup showed that the reported beneficial effects were not the same for each patient population. The reviewers concluded that more studies were needed to define the role of immunonutrients in different patient subgroups. (Clin Nutr 2003; 22: 221-233)

• Palmar and conjunctival pallor are important clinical signs for detection of anemia. The reliability and validity of these signs was studied in São Paulo, Brazil and it showed low levels of agreement. This study included 135 children aged 3 months to 6 years, admitted in a day-care center. Hemoglobin level results and palmar and conjunctival pallor assessment were used. Children with Hb under 11 g/dL were considered as anemic and subjective criteria were used for the assessment of palmar and conjunctival pallor. This study reported a greater level of sensitivity to conjunctival pallor than to palmar pallor. (Rev. Saúde Pública, 2003; 37: 404-408)

•  Therapeutic lung lavage for meconium aspiration syndrome is being investigated. A study was carried out in animal model of Meconium Aspiration Syndrome (2-week old piglets) with either dilute bovine surfactant (2.5 mg/ml) or a perfluorocarbon emulsion (20% wt/vol). There was improved oxygen-ation compared with a nonlavaged control group, but a sustained improvement in oxygenation was seen with dilute surfactant only. There was histologic and biochemical evidence of decreased lung injury in the dilute surfactant group. Further study of aliquot volume of 15 ml/kg vs. multiple 3ml aliquots showed increased meconium removal, better post-lavage lung function, and less lung injury with former. The authors concluded that dilute surfactant lavage using two 15-ml/kg aliquots is an effective therapy in the piglet model of meconium aspiration, and should be evaluated in human infants with this condition. (Am J Resp Crit Care Med 2003; 168: 456-463)

•  A systematic review of the interventions for Steroid Resistant Nephrotic Syndrome showed no significant difference in the number of children who achieved complete remission between Oral Cyclophosphamide + Prednisone vs. Prednisone alone, between Intravenous vs. Oral Cyclophosphamide, and between Azathioprine + Prednisone vs. Prednisone alone. Since there is paucity of data comparing the combinations of high-dose steroids, alkylating agents or Cyclosporin vs. single agents, placebo or no treatment, the authors concluded that more adequately powered and well-designed studies are needed. (Pediatr Nephrol 2003; 18: 906-912)

• A multicentre, double blind randomized control trial on oxygen saturation targets in extremely pre-term infants born before 30 weeks and their relation to growth and neurodevelopmental outcome at 12 months of age showed that there were no significant benefits of maintaining higher saturations. Babies who were oxygen dependent at 32 weeks postmenstrual age were randomly assigned to a target functional oxygen-saturation range of either 91 to 94 percent (standard-saturation group) or 95 to 98 percent (high-saturation group). The high-saturation group received oxygen for a longer period after randomization (median, 40 days vs. 18 days; P<0.001) and had a significantly higher rate of dependence on supplemental oxygen at 36 weeks of postmenstrual age and a significantly higher frequency of home-based oxygen therapy. (N Engl J Med 2003; 349: 959-967)

• The final word is out! The use of corticosteroids as adjuvant therapy in the treatment of acute bacterial meningitis has been controversial despite several controlled clinical trials and three meta-analyses. A Cochrane Review of all the published and non-published data concluded that adjuvant corticosteroids were associated with lower case fatality and lower rates of both severe hearing loss and long-term neurological sequelae. In children, corticosteroids reduced severe hearing loss in both Haemophilus influenzae meningitis as well as in meningitis caused by bacteria other than H. influenzae. Adverse events were not increased significantly with the use of corticosteroids. (The Cochrane Library, Issue 3, 2003. Oxford: Update Software).

Lokesh Guglani,
Resident,
Pediatric Cardiac Intensive Care Unit,
Escort Heart Institute & Research Center,
Okhla Road, New Delhi - 110 025,
India.
Email: [email protected]