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Indian Pediatr 2016;53: 268 |
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Clippings
Theme: General Pediatrics
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K Rajeshwari
[email protected]
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Administration of intravenous contrast for MRI
evaluation of headache (Isr Med Assoc J.2015;17:545-8)
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The aim of this study was to assess the necessity of routine contrast
administration in brain magnetic resonance imaging (MRI) of pediatric
outpatients referred for workup of chronic headache. A retrospective
review of consecutive pediatric brain MRI examinations in 30 pediatric
outpatients referred for evaluation of chronic headache was done.
Independent review was performed by two certified neuroradiologists. The
raters reviewed each MRI first as a non-contrast examination (without
seeing the post-contrast images) and then with post-contrast images. No
abnormalities were found in six patients. One patient had an
indeterminate finding of a tubular cerebellar lesion requiring
follow-up. In the remaining patients, the findings were subclinical and
included: mucosal thickening in the paranasal sinuses, cystic changes of
the pineal gland, small developmental venous anomalies, non-specific
FLAIR hyperintensities, opacification of the mastoids, and
telangiectasia. The subclinical cases that were missed on pre-contrast
images were: one small developmental venous anomaly, one telangiectasia
and one small pineal cyst, none of which hold clinical significance.
Authors concluded that there seems to be little reason to medically
justify routine use of intravenous contrast administration to evaluate a
brain MRI of pediatric patients referred for chronic headache.
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Early Azithromycin administration and
prevention of severe pneumonia (JAMA. 2015; 314:2034-44)
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Many preschool children develop recurrent, severe
episodes of lower respiratory tract illness (LRTI). This randomized
double-blind placebo-controlled trial, conducted across 9 US medical
centers, evaluated whether early administration of azithromycin, started
prior to the onset of severe symptoms, in preschool children with
recurrent severe LRTIs can prevent the progression of these episodes.
Participants were 607 children aged 12 through 71 months with histories
of recurrent, severe LRTIs and minimal day-to-day impairment.
Participants were randomly assigned to receive azithromycin (12 mg/kg/d
for 5 days) or placebo started early during each predefined respiratory
tract infection (RTI) .The primary outcome measure was the number of
RTIs not progressing to a severe LRTI. Presence of azithromycin-resistant
organisms in oropharyngeal samples, along with adverse events, were
among the secondary outcome measures. Azithromycin significantly reduced
the risk of progression to severe LRTI relative to placebo. Induction of
azithromycin-resistant organisms and adverse events were infrequently
observed. It was concluded that among young children with histories of
recurrent severe LRTIs, the use of azithromycin early during an apparent
RTI compared with placebo reduced the likelihood of severe LRTI. More
information is needed on the development of antibiotic-resistant
pathogens with this strategy.
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Traffic pollution and altered brain connectivity (Neuroimage.
2016;Jan 26. pii: S1053-8119(16)00051-3)
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Exposure to urban air pollution has been associated with poorer
cognitive performance. This study aimed to assess the extent of such
potential effects of urban pollution on child brain maturation using
general indicators of vehicle exhaust measured in the school environment
and a comprehensive imaging evaluation. A group of 263 children (age
8-12 y) underwent magnetic resonance imaging (MRI) to quantify regional
brain volumes, tissue composition, myelination, cortical thickness,
neural tract architecture, membrane metabolites, functional connectivity
in major neural networks, and activation/deactivation dynamics during a
sensory task. A combined measurement of elemental carbon and NO2 was
used as a putative marker of vehicle exhaust. Air pollution exposure was
associated with brain changes of a functional nature, with no evident
effect on brain anatomy, structure or membrane metabolites.
Specifically, a higher content of pollutants was associated with lower
functional integration and segregation in key brain networks. Higher
exposure was associated with slower brain maturation. In conclusion,
urban air pollution appears to adversely affect brain maturation in a
critical age with changes specifically concerning the functional domain.
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Vitamin D deficiency and sepsis (Paediatr Int Child
Health. 2016;36:15-21)
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This study investigated the prevalence of VDD in 124 critically ill
children (age 1-12 y) with sepsis admitted in a pediatric intensive care
unit (PICU) and 338 controls in Northern India over a one-year period.
Demographic data, clinical signs and risk factors for VDD, Paediatric
Index of Mortality III (PRISM III) score, and sequential organ failure
assessment (SOFA) score were recorded. Plasma 25-hydroxy vitamin D
[25(OH)D] levels were measured by ELISA within 24 hours of admission.
The occurrence of septic shock, multiple organ dysfunction syndrome
(MODS) and healthcare-associated infection (HCAI), need for mechanical
ventilation and catecholamines, length of PICU stay and mortality were
also recorded. Prevalence of VDD [25(OH)D level <50 nmol/L] was higher
among critically ill children with sepsis compared to healthy controls.
VDD was not associated with any significant difference in baseline
demographic variables or risk factors for VDD. Although there was a
trend toward increased PRISM III score, septic shock, MODS, HCAI, need
for mechanical ventilation and catecholamines, length of PICU stay, and
mortality, the difference was not statistically significant. Authors
concluded that a high prevalence of VDD in critically ill children with
sepsis was found but it was not associated with greater severity of
illness or other clinical outcomes.
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