 |
Clippings |
|
Amit P Shah
Email:
[email protected]
|
 |
Diabetic retinopathy screening in children – Start
later (Ophthalmology. 2015;doi: 10.1016/j.ophtha.2015.07.010)
|
|
Diabetes is the leading cause of blindness all over the world. It is
well recognized that early detection and treatment of diabetic macular
oedema and proliferative diabetic retinopathy reduces the risk for
vision loss. The current guidelines of American Academy of Ophthalmology
recommend annual screening for retinopathy in patients with type 1
diabetes to begin 5 years after diagnosis of diabetes, and the American
Academy of Pediatrics guidelines suggest starting annual examinations 3
to 5 years after the diagnosis of diabetes in children, or after the age
of 9 years, whichever occurs later. However, in children, the prevalence
of severe diabetic retinopathy and the importance of its screening have
not been clearly established.
This study aimed to investigate the prevalence and
onset of ocular disease, and its risk factors, in children with
diabetes, and consequently recommend a screening guideline for
asymptomatic children. On the basis of this study results and review of
the literature, researchers suggest that screening for ocular
complications of diabetes could begin later than suggested by current
guidelines. The screening examinations for retinopathy could begin at
age 15 years, or after 5 years of diabetes mellitus duration, whichever
occurs later, with an exception made for high-risk children and type 2
diabetic children.
|
|
|
Atropine 0.01% significantly reduces childhood
myopic progression (J AAPOS. 2015;doi:10.1016/j.jaapos.
2015.07.049)
|
|
Atropine and some other agents are known to have significant effect on
reducing the progression of myopia in children. The practical problem is
the side effects at the current recommended dosage. In this case-control
study, atropine 0.01% significantly reduced the rate of myopic
progression over one year with minimal side effects. Atropine in reduced
dosage may have potential to reduce progression of myopia.
|
|
|
Severity of dehydration in children – New
Canadian guideline(https://news.brown.edu/articles/2015/08/dhaka)
|
|
Diarrhea is one of the leading causes of death in developing world.
Assessment of dehydration is crucial for proper treatment. Canadian
researchers, working at International Centre for Diarrheal Disease
Research in Bangladesh, have come out with a very simple approach to the
diagnosis of severity of dehydration called DHAKA (Dehydration:
Assessing Kids Accurately).
In this study, they tracked 10 symptoms to see which
of them were accurately predictive of true dehydration severity. The
analysis found that just a few were needed to produce the combination of
high sensitivity (does it detect dehydration severity?) and high
specificity (does it rule out other possible problems?) needed to
provide an accurate diagnosis. This system includes both a simple
scoring tool and a decision-tree that clinicians can quickly apply in
their busy practice.
For the DHAKA Dehydration Score, these symptoms are the general
appearance and demeanor of a child, how quickly skin returns to smooth
after being pinched, whether breathing is unusually deep, and whether
tears are absent or only barely present when the child is crying. For
the DHAKA Dehydration decision-tree, a two-step flowchart process, the
symptoms were general appearance, and depending on that, either the skin
pinch or whether the child’s eyes appeared sunken. This is a new
simplified way to arrive at severity of the dehydration which needs
validation in different settings.
|
|
|
Streptococcal pharyngitis – When can children return to
school? (Pediatric Infect Dis J. 2015;doi:
10.1097/INF.0000000000000883)
|
|
Current recommendations suggest that children should not return to
school for at least 24 hours after starting antibiotics for a confirmed
group A streptococcal pharyngitis. This study found that even in the
late afternoon, a full dose of amoxicillin (50 mg/Kg) administered after
notification of positive rapid antigen detection test results for group
A streptococcus (GAS), resulted in non-detection of GAS in 91% of
children the next morning. Therefore, children treated with amoxicillin
for streptococcal sore throat by 5 PM of day 1 may, if afebrile and
improved, attend school on day 2. This can have implications for
financial savings and improved school attendance.
|
|
|
Dexamethasone better for inpatient asthma
treatment compared to prednisone (J Pediatr. 2015;doi:
10.1016/j.jpeds.2015.06.038)
|
|
We all know the importance of steroids in treatment of exacerbations of
asthma. Conventionally, prednisone is used for inpatient use. This study
suggested that dexamethasone is better for inpatient treatment, probably
due to its longer duration of action, palatable taste and milder side
effects. Dexamethasone therapy is shorter (2 days vs 5 days) than
prednisone), and patient and family compliance is much better.
|
|
|
Overweight teens – Protein-rich breakfast prevents body fat
gain (Obesity. 2015;23:1761-4)
|
|
Many young people frequently skip breakfast. Although breakfast is
suggested as a strategy to reduce an individual’s chance of obesity,
little is known if the type of breakfast consumed plays a significant
role in one’s health and weight management. In this study, researchers
compared the benefits of consuming a normal-protein breakfast to a
high-protein breakfast and found the high-protein breakfast – which
contained 35 grams of protein – prevented body fat gain, reduced daily
food intake and feelings of hunger, and stabilized glucose levels among
overweight teens who would normally skip breakfast.
|
