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In spite of
all our advanced diagnostic tools the importance of clinical history
cannot be negated! Acute appendicitis is common, frequently atypical,
challenging, and still associated with significant morbidity. Despite
major technologic advances, appendicitis remains primarily a clinical
diagnosis. Surprisingly, the relationship between heredity and
appendicitis is seldom considered. The authors addressed this question
prospectively over a 52-month period. Children who have appendicitis are
twice as likely to have a positive family history than are those with
right lower quadrant pain (but no appendicitis) and almost 3 times as
likely to have a positive family history than are surgical controls
(without abdominal pain). Thus they concluded that heredity is a
significant factor in pediatric patients who have appendicitis (J
Pediatr Surg 2001; 36:1214)
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Are mothers
with children having Neural Tube Defects (NTD) deficient in Zinc? Though
folic acid supplementation has reduced the incidence of NTD, it still
constitutes one of the important congenital malformations having wide
medical, social and ethical implications. This study was designed to
evaluate zinc status of the newborn babies with NTD and their mothers,
with 80 cases and the same number of controls. Serum and scalp hair zinc
levels were analyzed by atomic absorption spectrophotometry. This study
has found association between NTD and decreased hair zinc levels and
large population based studies are recommended to confirm the
association between zinc and NTD and to investigate whether zinc
supplementation would reduce the overall incidence of NTD. (Indian J
Pediatr 2001; 68: 522).
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Emerging drug
resistance threatens the effectiveness of existing therapies for
pneumococcal infections. Modifying the dose and duration of antibiotic
therapy may limit the spread of resistant pneumococci. A randomized
controlled trial was done to determine whether short-course, high-dose
amoxicillin therapy reduces risk of post treatment resistant
pneumococcal carriage among children with respiratory tract infections.
Children were randomly assigned to receive 1 of 2 twice-daily regimens
of amoxicillin: 90 mg/kg per day for 5 days (n = 398) or 40 mg/kg per
day for 10 days (n = 397). The authors conclude that short-course,
high-dose outpatient antibiotic therapy appears promising as an
intervention to minimize the impact of antibiotic use on the spread of
drug-resistant pneumococci (JAMA 2001; 286: 49).
- The authors report their
experience with high-dose oral methylprednisolone therapy (HDMP) in 15
infants with complicated hemangiomas. The starting dose for
methylprednisolone was 30 mg/kg/day for 5 days, then the dose was
tapered gradually every 5 days to 20, 10, 5, 2.5, and finally to 1
mg/kg/day. Overall, very good and good responses were obtained in 5,
partial response in 4, and therapy failure in 5 cases. Side effects were
not serious and resolved after discontinuation of treatment. Although
the number of patients is small in this study, overall response rate
with HDMP regimen does not seem to be superior to the regimens that use
lower doses (5 mg/kg/day), but it provides a high initial response rate
and the duration of therapy is short. Therefore the authors feel that it
may be useful for treating hemangiomas that fail to respond with low
doses, especially in centers with limited resources where other
treatment modalities can not be used at the moment (Pediatr Hemat Oncol 2001;
18: 335).
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Infants with
congenital heart disease and left-to-right shunts may develop
significant clinical symptoms of congestive heart failure in spite of
therapy with digoxin and diuretics. Therefore the role of beta-blockers
was investigated in treatment of infants with severe heart failure. It
was seen that additional propranolol treatment, but not digoxin
and diuretics alone actually reduced clinical symptoms of heart failure
in infants with congenital heart disease (Int J Cardiol 2001; 79: 167).
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How often does
meningeal irritation indicate bacterial meningitis? In this interesting
study the authors found that bacterial meningitis was present in 30% of
children with signs of meningeal irritation. Also no better prediction
of bacterial meningitis was achieved by using more specific tests for
signs of meningeal irritation (like Kernig’s) (Pediatr Emerg Care
2001; 17: 161).
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All of us who
have managed patients with Cerebral Palsy know the distress drooling
causes to the patient and parents. Considering the therapeutic spectrum
of botulinum toxin A and in view of the innervation of the salivary
glands, the authors injected it into the salivary gland of three CP
patients over a 4-month period. The maximal salivary flow rate of the
sublingual and submandibular glands was reduced by 51% to 63%. No
objectionable disturbances of oral functions were observed. Further
studies would allow us more insight in the role of this therapy for the
treatment of this difficult problem (Eur J Pediatr 2001; 160: 509).
Gaurav Gupta,
Senior Resident,
Department of Pediatrics,
Post Graduate Institute of Medical Education and
Research,
Chandigarh - 160 012,
India.
E-mail: [email protected]
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