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Indian Pediatr 2013;50: 976
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Amit P Shah
Email:
[email protected]
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Evidence-based guideline update from AAN: Vagus nerve
stimulation for the treatment of epilepsy (Neurology
10.1212/WNL.0b013e3182a393d1)
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Vagus nerve stimulation (VNS) is being used as adjunctive therapy for
reducing the frequency of seizures in patients older than 12 years with
partial-onset seizures refractory to antiepileptic medications since
1997.There are various reasons based on key findings of VNS that one
should consider it as a regular therapy in children also. As per this
new Guideline, VNS may be considered for seizures in children, for
LGS-associated seizures, and for improving mood in adults with epilepsy.
VNS may be considered to have improved efficacy over time. Children
should be carefully monitored for site infection after VNS implantation.
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Pepsin in bronchoalveolar lavage (BAL) fluid
to identify aspiration-associated extra-esophageal reflux
disease (AERD) in children with chronic respiratory symptoms
(JAMA Oto. doi:10.1001/jamaoto.2013.4448)
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The role of aspiration-associated extraesophageal reflux disease (AERD)
in patients with chronic respiratory symptoms is not well defined. This
study was done to determine the prevalence of AERD in patients with
chronic respiratory symptoms and to assess the utility of pepsin as a
new marker for AERD. Western blot analysis for pepsin and oil red O
staining for lipid-laden macrophages (LLMs) was performed on
bronchoalveolar lavage fluid specimens. It was found that presence of
pepsin was a better predictor of AERD in patients with respiratory
symptoms compared with controls than presence of LLMs. Thus, detection
of pepsin in bronchoalveolar lavage fluid specimens can serve as a
biomarker for AERD and is potentially superior to the current method of
measuring LLMs.
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Soft drinks linked to aggression, inattention
in younger kids also (J Pediatr DOI:
10.1016/j.jpeds.2013.06.023)
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Soft drinks are consumed by individuals of all ages, including very
young children. Although soft drink consumption is associated with
aggression, depression, and suicidal thoughts in adolescents, the
relationship has not been evaluated in younger children. A new study
finds that aggression, attention problems, and withdrawal behavior are
all associated with soft drink consumption in young children. A cohort
study in USA of 5-year-olds study group showed that those who drank 1 to
4 servings of soft drink per day had significantly higher aggressive
measurement scores than their peers who drank no soft drink and those
who consumed 2 or more servings had higher withdrawn behaviour scores,
and those who consumed 4 or more servings had higher attention problem
scores. The message is very clear that consumption of even 1 soft drink
per day may be associated with increased negative behavior in young
children and the simple message is that the consumption of water or milk
is more nutritious and a better alternative.
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Pyloric stenosis linked to low serum lipids in infants (JAMA.
2013;310:714-721)
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This study identified a new genome-wide significant locus for infantile
hypertrophic pyloric stenosis (IHPS). Characteristics of this locus
suggest the possibility of an inverse relationship between levels of
circulating cholesterol in neonates and risk of IHPS.
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Different PCV (pneumococcal vaccine) schedule – same
protection (JAMA 2013; 310: 930-937)
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This study compared immunogenicity of 4 different schedules using the
13-valent PCV (PCV13) to assess the optimal primary regimen with respect
to antibody induction. The schedules studied were - PCV13 either at ages
2,4, and 6 months (2-4-6); at ages 3 and 5 months (3-5); at ages 2,3,
and 4 months (2-3-4); or at ages 2 and 4 months (2-4), with a booster
dose at age 11.5 months.
Results are interesting! The researchers found that one month after
the booster dose, there were no differences in IgG geometric mean
concentrations (GMCs) between the schedules for 70 of 78 comparisons.
The 2-4-6 schedule was superior to the 2-3-4 schedule for serotypes 18C
and 23F and superior to the 2-4 schedule for serotypes 6B, 18C, and 23F.
For serotype 1, the 3-5 schedule was superior to the 2-4-6, 2-3-4, and
2-4 schedules. Secondary outcomes (GMCs measured 1 month after the
primary series, at 8 months of age, and before the booster) demonstrated
differences 1 month after the primary series. The 2-4-6 schedule was
superior compared with the 3-5, 2-3-4, and 2-4 schedules for 3,9, and 11
serotypes, respectively. Differences between schedules persisted until
the booster dose. The primary outcome of this study, GMCs l month after
the booster dose, showed that there were no statistically significant
differences between the 4 schedules in IgG levels for most serotypes.
However, differences between schedules were noted in secondary analyses.
Findings demonstrate that optimal timing of the primary series, i.e.,
older age at vaccinations combined with longer intervals between
vaccinations, is important to maintain optimal antibody levels during
the period between the primary series and the booster dose.
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