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Preview: Journal of Tropical Pediatrics - current issue

Journal of Tropical Pediatrics Current Issue





Published: Tue, 10 Oct 2017 00:00:00 GMT

Last Build Date: Tue, 10 Oct 2017 09:46:16 GMT

 



In this Issue 63/5

2017-10-10




The Important Role of Community Engagement and Social Capital in Child Health Systems

2017-10-10

Considerable research is developing interventions to promote child heath around the world. Recently, the World Health Organization (WHO) Collaborating Centre for Child and Neonatal Health at the Centre for International Child Health, University of Melbourne, published the 15th annual report of randomized controlled trials in child and adolescent health from the developing world [1]. This year, there were 235 trials on issues from acute respiratory infection to zinc conducted in 61 low and middle income countries. The growth in the strength of evidence on which to build healthcare for children across the globe is heartening. There are, however, gaps in the research, and one such area is the study of what communities can bring to health through their engagement in research and service delivery and their social capital. There are some papers of this type in the 2017 randomized controlled trial review with one trial of combining home garden, poultry and nutrition education programmes to improve anaemia [2] and five trials on the impact of community health workers and health education [3–7].



A Newborn with Transient Diabetes Mellitus Accompanied by Ketoacidosis Attributable to a ZFP57 Mutation

2017-02-18

Abstract
Hyperglycemia commencing within the first 6 months of life requires exogenous insulin therapy and, if the condition persists for >2 weeks, is termed neonatal diabetes mellitus (NDM). This rare illness is of two types: transient and permanent NDM. Most cases come to medical attention because of nonspecific symptoms, including intrauterine growth retardation, dehydration, difficulties in feeding and inadequate weight gain. In the present article, we describe an infant who smelt of ketones during examination and who was diagnosed with transient NDM caused by a ZFP57 mutation, accompanied by ketoacidosis. This is the first report of such a condition.



Paediatric Bone and Joint Infections in French Guiana: A 6 Year Retrospective Review

2017-02-15

Abstract
The epidemiology of paediatric bone and joint infections from South America is poorly known. We herein report a retrospective study conducted in whole French Guiana from January 2010 to December 2015. Medical charts of 55 previously healthy children were analysed, identifying 27 with osteomyelitis, 22 with septic arthritis and 6 with multifocal infections and/or osteoarthritis. The male:female ratio was 2.2:1, and the mean age was 7.5 years. Eighty percent children were ≥36 months old who had predominantly osteomyelitis related to methicillin-susceptible Staphylococcus aureus (p < 0.05) in the course of neglected skin infections. Five children presented with multi-systemic infections resulting in one fatality, mainly caused by S. aureus producing Panton-Valentine leucocidin (p < 0.01). In contrast, children aged 6–36 months had more likely culture-negative infections (p < 0.05), septic arthritis and mild clinical and biological features. Further prospective studies are required to better guide rational diagnostic and therapeutic strategies.



Profile of Tuberculous Cervical Lymphadenopathy in Children

2017-02-01

Abstract
Aim
Analyze clinical profile of tuberculous cervical lymphadenopathy in children.
Methods and Results
Of 1582 children with tuberculosis (TB), 63 (4%) had tuberculous cervical lymphadenopathy. The mean age at presentation was 7.4 ± 3.8 years (range of 1–14 years). Twenty-nine (46%) patients had bilateral lymphadenopathy, 17 (27%) each had left-sided and right-sided nodes. In 22 cases, culture was done, and 13 (59.1%) grew Mycobacterium tuberculosis of which 6 (46.2%) were drug resistant—1 (16.7%) was polyresistant, 1 (16.7%) was extremely drug resistant (XDR) and 4 (66.7%) were pre-XDR TB. Fifteen (23.8%) patients had TB in the past, of which 7 (46.7%) had previous cervical lymphadenopathy, 6 (40%) had pulmonary TB, 1 (6.7%) multifocal lymphadenopathy and 1 (6.7%) disseminated TB. Contact with a TB patient had occurred in 25 (39.7%) cases.
Conclusion
Tuberculous cervical lymphadenopathy is not so common in children. Bilateral involvement was more common. Mean age at presentation was 7.4 years. Drug resistance was prevalent in these patients.



Corticosteroid in Combination with Leflunomide and Mesenchymal Stem Cells for Treatment of Pediatric Idiopathic Pulmonary Hemosiderosis

2017-02-01

Abstract
Background
This study evaluated the efficiency of corticosteroid, leflunomide and mesenchymal stem cells (MSCs) in the treatment of pediatric idiopathic pulmonary hemosiderosis (IPH).
Methods
Ten patients were included in the study. The diagnosis of IPH was based on clinical symptoms, laboratory examinations and pulmonary hemosiderosis. Induction therapy consisted of methylprednisolone pulse therapy, followed by prednisone plus leflunomide. Maintenance therapy consisted of low-dose prednisone, leflunomide and administration of MSCs.
Results
All the patients achieved complete response after treatment with corticosteroid, leflunomide and MSCs. The median follow-up was 23 months (range: 4–34 months). Moreover, administration of MSCs induced an increase in the percentage of CD4+ CD25+ regulatory T cells but a decrease in the percentage of Th17 cells.
Conclusion
Treatment with corticosteroid, leflunomide and MSCs for pediatric IPH was safe and effective.



Evidence to Support Oxygen Guidelines for Children with Emergency Signs in Developing Countries: A Systematic Review and Physiological and Mechanistic Analysis

2017-02-01

Abstract
There are currently no evidence-based oxygen saturation targets for treating children with life-threatening conditions. We reviewed evidence of SpO2 targets for oxygen therapy in children with emergency signs as per WHO Emergency Triage Assessment and Treatment guidelines. We systematically searched for physiological data and international guidelines that would inform a safe approach. Our findings suggest that in children with acute lung disease who do not require resuscitation, a threshold SpO2 for commencing oxygen of 90% will provide adequate oxygen delivery. Although there is no empirical evidence regarding oxygen saturation to target in children with emergency signs from developing countries, a SpO2 of ≥ 94% during resuscitation may help compensate for common situations of reduced oxygen delivery. In children who do not require resuscitation or are stable post resuscitation with only lung disease, a lower limit of SpO2 for commencing oxygen of 90% will provide adequate oxygen delivery and save resources.



Development and Implementation of a Training-of-Trainers Program for Continuous Positive Airway Pressure in Neonatal and Pediatric Patients in Five Low- and Middle-Income Countries

2017-01-25

Abstract
We describe a pragmatic training-of-trainers program for the use of continuous positive airway pressure (CPAP) for neonatal and pediatric patients. The program is designed for medical professionals working in low- and middle-income countries and involves 2 days of in-class training followed by 1 day of in-service training. The program was created after training in Cambodia, Ghana, Honduras, Kenya and Rwanda and addresses the issues of resource availability, cultural context and local buy-in and partnership in low- and middle-income countries. We hope others will use the training program to increase knowledge and use of CPAP with the ultimate goal of improving neonatal and pediatric survival globally.



Reduction of Neonatal Mortality Requires Strengthening of the Health System: A Situational Analysis of Neonatal Care Services in Ballabgarh

2017-01-25

Abstract
Background
Planning a comprehensive program addressing neonatal mortality will require a detailed situational analysis of available neonatal-specific health infrastructure.
Methods
We identified facilities providing essential and sick neonatal care (ENC, SNC) by a snowballing technique in Ballabgarh Block. These were assessed for infrastructure, human resource and equipment along with self-rated competency of the staff and compared with facility-based or population-based norms.
Results
A total of 35 facilities providing ENC and 10 facilities for SNC were identified. ENC services were largely in the public-sector domain (68.5% of births) and were well distributed in the block. SNC burden was largely being borne by the private sector (66% of admissions), which was urban-based. The private sector and nurses reported lower competency especially for SNC. Only 53.9% of government facilities and 17.5% of private facilities had a fully equipped newborn care corner.
Conclusions
Serious efforts to reduce neonatal mortality would require major capacity strengthening of the health system, including that of the private sector.



Soil-Transmitted Helminthiasis and Schistosomiasis in Children of Poor Families in Leyte, Philippines: Lessons for Disease Prevention and Control

2017-01-24

Abstract
Objective
Neglected tropical diseases (NTDs) continue to be a public health problem in the Philippines. We assessed the association of soil-transmitted helminthiasis (STH) and schistosomiasis with selected health-related and socioeconomic variables in four villages in Leyte, Philippines.
Methods
Stool specimens from 418 adults and 533 of their children from 209 families were examined through the Kato-Katz technique.
Results
STH and schistosomiasis were present in 64.6% and 12.5%, respectively, of study participants. Analysis through the generalized linear mixed model revealed a number of associations between infection in parents and their children. Findings indicate that years of disease prevention and control efforts in these areas have been unable to bring down prevalence in children and their parents. Eliminating NTDs as public health problems will require a systems thinking approach beyond implementation of vertical control programs alone.



Assessment of Neonatal Pain During Heel Prick: Lancet vs Needle—A Randomized Controlled Study

2017-01-21

Abstract
Background
Heel prick is a frequent painful procedure in newborns. A lancet or a 26-gauge needle is used for a heel prick in India.
Objective
To compare the pain caused by heel prick with a lancet or a 26-gauge needle in newborns admitted in the neonatal intensive care unit (NICU) using the preterm infant pain profile (PIPP).
Methods
This randomized controlled trial was conducted over 2 months in a Level III NICU with a sample size of 40 subjects (20 in each group), which was required for the study to have a power of 80% with an alpha error of 0.05. Hemodynamically stable newborns on at least those on partial oral feeds undergoing heel prick for routine glucose monitoring were randomized into two groups within 48 h of NICU admission after informed parental consent: heel prick with a lancet or with a 26-gauge needle using computer-generated random numbers. Two milliliters of expressed breast milk was given 2 min before the heel prick. Pain before, during and after (1 and 5 min) was assessed using the PIPP score. The primary outcome measure was the PIPP score. The secondary outcome measures were the duration of audible cry and the number of pricks needed for an adequate sample. Statistical analysis was done using the Mann Whitney U test and Friedman’s test on SPSS v.21. A p value of < 0.05 was significant.
Results
There were 40 neonates, 24 males and 16 females included in the study with a median age of 7 days. The mean birth weight was 2441 g (SD: 699) at a mean gestation of 34.4 weeks (SD: 3.2). The median PIPP scores at 0–30 s after heel prick were 7.05 ± 3.57 with a lancet vs. 9.35 ± 3.68 a needle (p = 0.052). There was a significantly lower duration of audible cry with use of lancet (10.5 ± 18.5 s vs. 75.2 ± 12.0 s with needle; p = 0.03). All heel pricks resulted in adequate sampling.
Conclusion
Heel prick with a lancet causes less crying than a 26-gauge needle, though the PIPP scores are not significantly different.



Super-refractory Status Epilepticus with Hemophagocytic Syndrome in a Child with HIV Infection

2017-01-14

A 3.5-year-old boy was referred for the diagnosis and management of refractory seizures. He had been previously well but 10 days prior had an upper respiratory tract infection. Three days later, he had right-sided involuntary limb movements and facial twitching. Initially, these episodes were brief with preserved consciousness, but they gradually increased in duration with alteration in the sensorium in the form of unresponsiveness and excessive crying. He was initially treated with phenytoin, valproate and levetiracetam, but the seizures remained refractory. On examination, the child was underweight (11 kg; z-score between −2 and −3) with no meningeal signs, rash, organomegaly, lymphadenopathy, papilledema or focal neurological deficits.



Seroprevalence of Toxocariasis in Children with Urticaria: A Population-based Study

2017-01-10

Abstract
Objective
This study described the prevalence of IgG class antibodies against Toxocara spp. and their association with urticaria in 2- to 12-year-old children.
Methods
This population-based cross-sectional study was conducted between May 2012 and September 2014. The study sample comprised 168 children. Blood samples were collected to verify the presence of toxocariasis by using ELISA to detect IgG antibodies. The guardians of the children were interviewed to characterize the presence or absence of other diseases, such as urticaria.
Results
The presence of urticaria was observed in 38% of participants. The seroprevalence of toxocariasis in this population was 16%. This study confirmed a positive association between urticaria and positive serology for Toxocara and a negative independent association with canine contact and the number of household residents.
Conclusions
There are no previous reports in the literature of a population-based study that correlates the presence of urticaria with serology for toxocariasis.



Umbilical Venous Catheter Versus Peripherally Inserted Central Catheter in Neonates: A Randomized Controlled Trial

2017-01-10

Abstract
Peripherally inserted central catheter (PICC) and umbilical venous catheter (UVC) in terms of success rate, complications, cost and time of insertion in neonatal intensive care were compared. Neonates requiring vascular access for minimum 7 days were included. Sample size of 72 per group was determined. Trial was registered at Clinical Trials Registry of India (CTRI/2015/02/005529). Success rates of the UVC and PICC were 68.1% and 65.3%, respectively (p = 0.724). Mean (SD) time needed for PICC and UVC insertion was 34.13 (34.69) and 28.31 (17.19) min, respectively (p = 0.205). Mean (SD) cost of PICC insertion vs. UVC insertion was 60.9 (8.6) vs. 11.9 (8.7) US dollars (p < 0.0001). Commonest cause for failure of UVC was displacement [6 (8.3%)] and that for PICC was blockage [9 (12.5%)]. Conclusions: UVC is a cheaper alternative to PICC, with similar success rate, short-term complications and time needed for insertion.