|
Clippings |
Amit P Shah
Email:
[email protected]
|
|
Long-term prophylactic mupirocin useful in reducing
S.aureus colonization and infection in high-risk neonates (J
Perinatol. 201; DOI: 10.1038/jp.2012.102).
|
This study to examine the use of long-term prophylactic mupirocin was
done in USA as part of a comprehensive strategy in reducing S. aureus
colonization and infection in a neonatal intensive care unit (NICU).
Twice daily mupirocin was applied to all infants admitted to the NICU
throughout hospitalization starting in 2004, which is now a routine.
This twice daily application of muciprocin regime was stopped in between
to study the results. During the study period, there were three
distinctive S. aureus outbreaks, the first being a methicillin-resistant
strain in July 2004. After implementation of daily mupirocin, the
outbreak was eradicated and the rate of S. aureus infection
significantly decreased. Mupirocin was discontinued in March 2005
followed by a methicillin-sensitive S. aureus outbreak in
November 2005. In December 2005, mupirocin was reinstituted again,
significantly reducing S. aureus infections with zero isolates
resistant to mupirocin. Although controversial, this study has
established clear benefits of prophylactic mupirocin in all NICU
infants. Mupirocin has acted as a barrier to colonization and markedly
decreased S. aureus infection rates over a 5-year period.
|
|
Asthma worsens with step-off therapy (Arch
Intern Med 2012; DOI: 10.1001/ archinternmed.2012.3250).
|
This review from Canada suggest that discontinuation of long-acting
beta-agonist (LABA) therapy in patients whose asthma is well controlled
is associated with a worsening of symptom control and quality of life.
In 2010 the FDA determined that LABAs should carry a black box warning
and advised that discontinuation of the drugs should begin once patients
gain and maintain adequate asthma control. In contrast to FDA
recommendations of stepping off [long-acting beta-agonist] therapy when
asthma is controlled, this study supports the continued use of these
agents to maintain asthma control. The final word is not yet out; the
controversy should add to more research in the area.
|
|
Diagnosis and management of childhood
obstructive sleep apnea syndrome – a new guideline (Pediatrics
2012, DOI: 10.1542/peds.2012-1671).
|
This revised clinical guideline from American Academy of Pediatrics
(AAP) provides recommendations for the diagnosis and management of the
obstructive sleep apnea syndrome (OSAS) in children and adolescents.
1. All children/adolescents should be screened
for snoring.
2. Polysomnography should be performed in
children/adolescents with snoring and symptoms/signs of OSAS; if
polysomnography is not available, then alternative diagnostic tests
or referral to a specialist for more extensive evaluation may be
considered.
3. Adenotonsillectomy is recommended as the
first-line treatment of patients with adenotonsillar hypertrophy.
4. High-risk patients should be monitored as
inpatients postoperatively.
5. Patients should be reevaluated postoperatively
to determine whether further treatment is required. Objective
testing should be performed in patients who are high risk or have
persistent symptoms/signs of OSAS after therapy.
6. Continuous positive airway pressure is
recommended as treatment if adenotonsillectomy is not performed or
if OSAS persists postoperatively.
7. Weight loss is recommended in addition to
other therapy in patients who are overweight or obese.
8. Intranasal corticosteroids are an option for children with mild
OSAS in whom adenotonsillectomy is contraindicated or for mild
postoperative OSAS.
|
|
Serum vitamin D levels are lower in children
and adolescents with type 1 diabetes (Pediatric Diabetes
2012; DOI: 10.1111/j.1399-5448.2012.00890.x)
|
Vitamin D is synthesized in the skin through the action of UVB
radiation (sunlight); and 25-hydroxy vitamin D (25OHD) is
measured in serum as a marker of vitamin D status. Several
studies, mostly conducted in high latitudes, have shown an
association between type 1 diabetes mellitus (T1DM) and low
serum 25OHD where sunlight is not available in abundance. This
interesting study confirmed this even in Australian children in
spite of abundant sunlight. The authors found serum 25OHD levels
to be significantly lower in children with type 1 diabetes
compared with children without diabetes. These levels remained
lower after adjustment for covariates, including mean ambient
ultraviolet radiation index, as the majority of participants
with type 1 diabetes had their vitamin D measured in the fall
and winter, whereas the control patients were assessed in the
spring and summer months. Children with type 1 diabetes had
lower self-reported levels of outdoor exposure and mean
ultraviolet exposure; however, there were no significant
differences between the 2 groups in terms of vitamin D receptor
polymorphisms, which have been linked with autoantibodies and
diabetes-related complications. This study shows that even at
relatively low latitude in an environment of abundant sunlight
exposure, pediatric patients with diabetes have low vitamin D
compared to their peers, the effect being more marked in those
newly diagnosed, but still present in those with established
diabetes.
|