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Indian Pediatr 2012;49:425
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Gaurav Gupta
Email:
drgaurav@charakclinics.com
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Do common childhood infections affect asthma risk in adults? Results
from a longitudinal study over 37 years! (Chest; March 2012)
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Few studies have examined common childhood infections and adult asthma.
This study examined associations between childhood infectious diseases,
childhood pneumonia and current, persisting and incident asthma to
middle age. It analyzed data from the Tasmanian Longitudinal Health
Study (TAHS). A history of pneumonia was ascertained from their parents
when the TAHS participants were 7 years old. Measles, rubella, mumps,
chickenpox, diphtheria and pertussis were identified from school medical
records. Greater infectious diseases load was negatively associated with
persisting asthma at all ages. Individually, chicken-pox (aOR 0.58;
0.38-0.88) was negatively associated with asthma persisting to age 32
years and rubella was negatively associated with asthma persisting to
ages 32 (aOR 0.61; 0.31-0.96) and 44 years (aOR 0.53; 0.35-0.82).
Pertussis was associated with pre-adolescent incident asthma (adjusted
Hazard Ratio [aHR] 1.80; 95% CI 1.10-2.96) while measles was associated
with adolescent incident asthma (aHR 1.66; 1.06-2.56). Childhood
pneumonia was associated with current asthma at ages 7 (aOR 3.12;
2.61-3.75) and 13 years (aOR 1.32; 1.00-1.75), an association stronger
in those without than those with eczema. Overall, childhood infectious
diseases protected against asthma persisting in later life but pertussis
and measles were associated with new-onset asthma after childhood.
Measles and pertussis immunization might lead to a reduction in incident
asthma in later life.
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Does maternal depression predict developmental
outcome in 18 month old infants? (Early Human
Development; Feb 2012)
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The aim of this study was to examine the associations between
maternal depression in the first 6 months postpartum, home
environment and cognitive, language and motor development in
infants at 18 months of age. This article reports results from
the control group (n=312 full term; n=48 preterm)
of the prospective Docosahexaenoic acid (DHA) to Optimise
Maternal Infant Outcome (DOMInO) randomized controlled trial.
Mothers in South Australia completed the Edinburgh Postnatal
Depression Scale (EPDS) at 6 weeks and 6 months postpartum.
Infant development was assessed when children were 18 months old
with the Bayley Scales of Infant and Toddler Development Version
III and mothers completed the home screening questionnaire at
this assessment. There were no significant associations between
maternal depression in the first 6 months postpartum and
cognitive, language or motor development after controlling for
infant prematurity, breastfeeding status and socio-economic
level. Home environment remained a significant predictor of
development after controlling for potential confounding
variables.
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Can clinical findings be used to rule out
streptococcal pharyngitis? A systematic review (J Pediatr; March
2012)
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Two authors independently searched MEDLINE and EMBASE including articles
containing data on the accuracy of symptoms or signs of streptococcal
pharyngitis, individually or combined into prediction rules, in children
3-18 years of age. Thirty-eight articles with data on individual
symptoms and signs and 15 articles with data on prediction rules met all
inclusion criteria. In children with sore throat, the presence of a
scarlatiniform rash (likelihood ratio [LR], 3.91; 95% CI, 2.00-7.62),
palatal petechiae (LR, 2.69; CI, 1.92-3.77), pharyngeal exudates (LR,
1.85; CI, 1.58-2.16), vomiting (LR, 1.79; CI, 1.58-2.16), and tender
cervical nodes (LR, 1.72; CI, 1.54-1.93) were moderately useful in
identifying those with streptococcal pharyngitis. Nevertheless, no
individual symptoms or signs were effective in ruling in or ruling out
streptococcal pharyngitis. Symptoms and signs, either individually or
combined into prediction rules, cannot be used to definitively diagnose
or rule out streptococcal pharyngitis.
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Can malodorous urine predict a UTI? (Pediatrics, Published
online April 2, 2012).
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The authors conducted a prospective consecutive cohort study in the
emergency department of a pediatric hospital from July 31, 2009 to April
30, 2011. All children aged between 1 and 36 months for whom a urine
culture was prescribed for suspected UTI (ie, unexplained fever,
irritability, or vomiting) were assessed for eligibility. A standardized
questionnaire was administered to the parents. The primary outcome
measure was a UTI. Three hundred ninety-six children were initially
enrolled, but 65 were excluded a posteriori due to non-availability of
appropriate urine culture result. The median age of enrolled children
was 12 months (range, 1–36). Criteria for UTI were fulfilled in 51
(15%). Malodorous urine was reported by parents in 57% of children with
UTI and in 32% of children without UTI. On logistic regression,
malodorous urine was associated with UTI (odds ratio 2.83, 95%
confidence interval: 1.54–5.20). This association remained statistically
significant when adjusted for gender and the presence of vesicoureteral
reflux.Parental reporting of malodorous urine increases the probability
of UTI among young children being evaluated for suspected UTI. However,
this association is not strong enough to definitely rule in or out a
diagnosis of UTI.
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