bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Features, Diagnosis, and Treatment of Tuberculosis in Infants
Authors: Vallejo Jesus G. , Ong Lydia T. , Starke Jeffrey R.
Published: December 2021

Objective. Despite the recent resurgence of tuberculosis among children in the United States, no series of infants <1 year of age with tuberculosis has been reported in the last 20 years. This study was undertaken to describe the epidemiology, clinical, and radiographic manifestations, and response to therapy in infants <1 year of age with tuberculous disease.

Methods. The medical records were reviewed for all infants age 12 months or less with a diagnosis of tuberculosis and cared for at the Children's Tuberculosis Clinic at Ben Taub General Hospital in Houston, Texas between January 1, 1985 and June 30, 1992.

Results. Of the 47 infants identified, 51% were female. The median age at diagnosis was 8 months (range 3.5 to 12 months). Fifty-one percent of the infants were African-American and over one-third were Hispanic. All patients were born in the United States. Diagnosis resulted from the examination of an ill infant in 79% of cases, a case contact investigation of an adult suspected of having tuberculosis in 19%, and routine tuberculin skin testing in 2%. An adult with infectious tuberculosis who had contact with the infant was identified in 68% of cases. Intrathoracic disease alone was present in 70% of cases. Fourteen (30%) infants had extrapulmonary tuberculosis (11 central nervous system disease, 2 disseminated disease, and 1 cervical adenitis). Gastric aspirate cultures yielded Mycobacterium tuberculosis from 75% of the infants with isolated intrathoracic disease. Forty-five infants successfully completed therapy and only one death was directly related to tuberculosis. Forty-eight percent of the infants with pulmonary tuberculosis were treated with a 6-month regimen consisting of isoniazid and rifampin supplemented during the first 2 months by pyrazinamide. Eighteen infants received some twice weekly directly observed therapy mainly due to documented or suspected nonadherence. Treatment was well-tolerated; one patient (2%) developed hepatotoxicity due to isoniazid. No infant had a relapse or recurrence of disease in 6 months to 7 years follow-up for a median of 3 years (range, 6 months to 7 years).

Conclusion. Most infants with tuberculosis are symptomatic at the time of diagnosis, and bacteriologic confirmation was obtained in 70% of cases. A contact investigation of the household should be initiated immediately when an infant is suspected of having tuberculosis because valuable information needed to establish the diagnosis and guide therapy in the infant may be obtained. Intensive 6-month and twice weekly directly observed therapy appear to be well-tolerated and effective for the treatment of pulmonary tuberculosis in infants.
The Prone Alternative
Authors: Orenstein Susan R.
Published: December 2021

Having attended both National Institutes of Health (NIH) meetings on infant sleep position (March 30 through 31, 1992, and January 13 through 14, 1994), and having publically expressed a minority view that the advantages of supine position in the United States might be outweighed by the disadvantages,1,2 I have been queried about whether my views have changed since the second NIH meeting. Most recently, Dr John Kattwinkel, of the American Academy of Pediatrics Task Force on Sleep Positioning and Sudden Infant Death Syndrome (SIDS), was kind enough to request my response to the report of the second meeting.3 This response is as follows.
Treatment of a Jehovah's Witness with Immune Globulin: Case of a Child with Kawasaki Syndrome
Authors: Roy-Bornstein Carolyn , Sagor Linda D. , Roberts Kenneth B.
Published: December 2021

Immune globulin for injection or infusion has been used as a prophylactic and therapeutic treatment in such diverse conditions as Kawasaki disease, idiopathic thrombocytopenic purpura, Guillain-Barré syndrome, and hepatitis B.8 Pediatricians may care for Jehovah's Witness children who have these disorders. The biological precedent of active immunoglobulin transfer during fetal life identifies immune globulin as different than red blood cells and provides a rationale for Jehovah's Witnesses to accept immune globulin therapy for their children without compromising their religious beliefs.
Multiple Africanized Bee Stings in a Child
Authors: Ariue Barbara K.
Published: December 2021

African honey bees, Apis mellifera scutellata (formerly adsonii) were imported to Brazil in 1956 to introduce a strain of bees with increased honey production which were more suited for the tropical climate.1,2 A year later, 26 African queen bees and their accompanying colonies accidentally escaped.1,2 The African queen bees soon began mating with established European bee races resulting in the hybrid Africanized honey bees.2 Like the pure African bees, the Africanized bees are more defensive with a greater tendency to sting than European bees.3 They respond quickly to the slightest disturbance of their nest and can send out many thousands of bees.
PCBs in Breast Milk
Authors:   Committee on Environmental Health
Published: December 2021

Environmental chemicals have been found in human milk since the 1950s, and periodically there are reports of polychlorinated biphenyls (PCBs) in breast milk. Polychlorinated biphenyls are stored in body fat and are not readily excreted except in the fat of breast milk. PCB manufacture ceased in the US in the 1970s.

The routes of PCB exposure for the general population are not known in detail, but low-level contamination of food is a likely source. Persons who consume fish from contaminated waters, such as the Hudson River and Lake Michigan, may have greater exposure to PCBs. Opportunity still exists for skin to come in contact with and absorb PCBs from old electrical or laboratory equipment.

BACKGROUND

Studies in the US

In the US there are no known clinical effects of exposure to PCBs through breast milk. Two cohorts of US children—one in Michigan with about 250 children and the other in North Carolina with about 750 children—whose development was followed from birth had their exposure to PCBs measured. In the North Carolina study, prenatal exposure to PCBs but not exposure through breast milk was associated with poorer performance on the Psychomotor Index from the Bayley Scales of Infant Development from 6 months through 24 months of age.1,2 In the Michigan study, poorer visual recognition memory performance in 7-month-old infants was associated with cord serum PCB level and maternal contaminated fish consumption.3 There was no relation with breast milk exposure.

Studies in Asia

"Yusho" and "yucheng" both mean oil disease in Japanese and Chinese, respectively.
HARD TO SWALLOW
Authors: L. J. F.
Published: December 2021

British battery maker Ever Ready is patenting an idea for making small batteries child-proof. Batteries no bigger than buttons are just the right size for children to swallow but contain poisonous chemicals such as zinc and mercury.

Ever Ready plans to douse these batteries in a solution of denatonium benzoate, an intensely bitter chemical that is sold under the trade name Bitrex. The batteries are then heated in air to 120°C for four or five minutes. The chemical hardens as a surface coating, like sugar round a sweet.
A Randomized Trial of a Nursing Intervention to Promote the Adjustment of Children with Chronic Physical Disorders
Authors: Pless Ivan Barry , Dougherty Geoffery , Willard Barbara , Feeley Nancy , Gottlieb Laurie , Rowat Kathleen
Published: December 2021

Objective. This study was conducted to determine whether a specialized form of nursing could help prevent or reduce psychosocial maladjustment among children, aged 4 to 16 years, with chronic physical disorders. In contrast to other studies, nurses were chosen to provide the intervention based on their central role in health care and the appropriateness of their training for this task.

Methodology. A clinical trial was conducted in which 332 children and their families were randomly assigned either to receive this specialized nursing for a 1-year period, or to remain in the control condition. The children were all active outpatients in nine clinics at the Montreal Children's Hospital. Three measures of psychosocial functioning administered before and after the intervention were the basis for assessing its efficacy. The measures included the behavior problems profile of the Achenbach Child Behavior Checklist, the Personal Adjustment and Role Skills, completed by the parents, and two versions of the Self-Perception Profile (Harter) for children aged 4 to 7 years and 8 to 16 years.

Results. Differences between groups were examined both categorically and quantitatively. In the former, the percent of children with clinical scores (those above or below a cut-off indicative of maladjustment) at baseline and postintervention were compared In the latter, the mean scores at the end of the trial were analyzed using analysis of covariance with the baseline scores as covariates. Statistically significant positive differences were found in the domain of anxiety/depression on the Personal Adjustment and Role Skills, and in the areas of scholastic competence, behavior, and global self-worth on the Harter.

Conclusion. The results indicate that this intervention helps children with chronic disorders by preventing or reducing maladjustment Most university-prepared nurses already have the basic skills required to achieve these results; only a modest investment in reorientation may be needed. Thus, other pediatric centers should be able to replicate these findings and thereby take a major step toward improving the lives of children with chronic disorders.
EFFECTIVE? MAYBE. PROFITABLE? CLEARLY
Authors: L. J. F.
Published: December 2021

SANTA ANA, CALIF.—The Tokos Medical Corporation, which sells a service that detects early labor in pregnant women, recently started a program to reward obstetricians who ordered it for their patients.

In its ifies the company called the program "Dr. Deal." The deal: earn up to $20,000 annually on an investment of $1,000.

The program, in which 300 to 400 obstetricians nationwide are participating, works like this: The doctors put up $1,000 each to become shareholders in a company set up by Tokos that typically exists only on paper. In return, the doctors pocket 15 percent of the payment for any Tokos services prescribed by members of the physician-owned company. Tokos says participating physicians currently average about $5,000 a year from the arrangement; literature from one Tokos subsidiary boasted that annual earnings could reach $22,500

But a debate is growing about the effectiveness of the home uterine monitor that is the keystone of Tokos's service. The Food and Drug Administration is also investigating Tokos's marketing claims. Separately, there is a scientific controversy about the safety of the drugs Tokos sells to prolong pregnancy.

Some doctors are concerned about not only Tokos's marketing practices but also the willingness of some physicians to take part in its investment plans. "It is a sad day for medicine," say Dr. Benjamin Sachs, chief of obstetrics and gynecology at Beth Israel Hospital in Boston.

A look at Tokos's marketing efforts highlights one of the most troubling issues in health care: Medical companies often go to great lengths to encourage doctors to use their products, and to persuade insurers to pay for them.
CONFUSION AND ERROR ARE RIFE IN HOSPITAL BILLING PRACTICES
Authors: L. J. F.
Published: December 2021

At a time when the General Accounting Office has estimated that 99 percent of hospital bills contain overcharges, these bills have become so complicated and so lengthy that no mere mortal patient can read them or spot mistakes. Itemized bills for even brief hospitalizations run several pages and those for major surgery, like a heart bypass, can be dozens of pages.

If mistakes go unnoticed, the patient or insurer can end up paying too much. In addition, health-care experts say the complicated bills make it virtually impossible for patients to compare costs at hospitals. In both ways, these bills can contribute to worsening inflation in health care.

"You have these incomprehensible bills with millions of little items and for each a price," said Dr. Uwe Reinhardt, a health economist at Princeton University. "The American hospital bill is a source of great humor in the world health economics community; people just laugh."
A CHANGE OF ASSOCIATE EDITORS
Authors: L. J. F.
Published: December 2021

Dr. Birt Harvey has been the Associate Editor of Pediatrics for the past three years. His distinguished background in pediatric practice, academic medicine, and Presidency of the American Academy of Pediatrics gave him a unique background that was invaluable to the journal at a critical time leading up to the current health care revolution. I valued his judgement, guidance, and boundless energy. He dragged us into the computer age. I will miss him. Birt will continue to be associated with the journal as an advisor and reviewer of special manuscripts. He's not the kind of doctor who can ever retire!

Dr. Ralph Feigin, Chairman of the Department of Pediatrics at Baylor College of Medicine, will be the new Associate Editor. Ralph brings a different but equally impressive background to the journal. He's an internationally recognized infectious disease expert, a master teacher, and an experienced, creative academic administrator of the largest pediatric department in the world! He obviously also has boundless energy. I am counting on this!
Ambulatory Blood Pressure Recordings in Children and Adolescents
Authors: Harshfield Gregory A. , Alpert Bruce S. , Pulliam Derrick A. , Somes Grant W. , Wilson Dawn K.
Published: December 2021

Objective. To provide reference data for ambulatory blood pressure monitoring (ABPM) and to determine the influence of age, sex, and race on these values.

Methods. ABPM was performed on 300 healthy, normotensive boys and girls between the ages of 10 and 18 years, including 160 boys and 140 girls, of whom 149 were white and 151 were black. Mean systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) while awake and during sleep were calculated for black and white boys and girls aged 10 to 12 years, 13 to 15 years, and 16 to 18 years.

Results. Boys compared with girls 10 to 12 years of age had higher mean (±SD) SBP (115 ± 9 vs 112 ± 9 mm Hg; P < .01) and DBP (67 ± 7 vs 65 ± 5 mm Hg; P < .01) while awake. Boys compared to girls 13 to 15 years of age had higher SBP while awake (116 ± 11 vs 112 ± 8 mm Hg; P < .01). Boys compared with girls 16 to 18 years of age had higher SBP while awake (125 ± 12 vs 111 ± 9 mm Hg; P < .01) and during sleep (116 ± 11 vs 106 ± 9 mm Hg). Comparisons within sex showed similar changes with age for boys and girls. Blacks compared with whites 13 to 15 years of age had higher SBP during sleep (109 ± 11 vs 105 ± 10 mm Hg; P < .01), and blacks compared with whites 16 to 18 years of age had higher DBP during sleep (66 ± 7 vs 58 ± 6 mm Hg; P < .01). Comparisons across age groups within race showed that blacks 16 to 18 years of age had higher SBP during sleep than blacks 10 to 12 years of age (109 ± 11 vs 104 ± 10 mm Hg), and higher DBP during sleep (66 ± 7 mm Hg; P < .01) than blacks 10 to 12 years of age (61 ± 7 mm Hg; P < .01) and 13 to 15 years of age (61 ± 8; P < .01 mm Hg). The changes with age were not significant for white subjects.

Conclusion. These results provide age-specific reference data for ABPM in youths. These values differ by sex (boys more than girls) and race (Blacks more than Whites).
Cognitive Effects of Lyme Disease in Children
Authors: Adams Wayne V. , Rose Carlos D. , Eppes Stephen C. , Klein Joel D.
Published: December 2021

Objective. To measure possible cognitive sequelae of Lyme disease (LD) within a pediatric population.

Design. Prospective, blinded, controlled study of cognitive skills in children who had been treated for LD.

Setting. A children's hospital in an area endemic for LD.

Patients. Forty-one children with strictly defined LD were compared with 14 control children who had subacute rheumatological diseases, and with 23 healthy sibling controls.

Outcome measures. Neuropsychologic measures were administered to each child to assess the following cognitive areas: IQ, information processing speed, fine-motor dexterity, novel-problem solving and executive functioning, short-term and intermediate memory, and the ability to acquire new learning. Predisease and postdisease academic achievement test scores were also gathered. Impressions from parents concerning the disease's subsequent impact were also obtained.

Results. No differences between LD and control groups were found for any of the numerous neuropsychologic measures. Analyses also failed to show differences between LD patients grouped with respect to the presence or absence of known neurologic involvement, disease stage, duration of symptoms before therapy, or type of antibiotic treatment. No predisease versus postdisease difference in academic performance was found. No perceived long-term deterioration in cognitive, social, or personality areas was reported by parents.

Conclusion. Children appropriately treated for LD have an excellent prognosis for unimpaired cognitive functioning.
Incidence of Renal Anomalies in Children Prenatally Exposed to Ethanol
Authors: Taylor Carolyn L. , Jones Kenneth L. , Jones Marilyn C. , Kaplan George W.
Published: December 2021

Objective. Based on a number of studies involving animals as well as human case reports indicating an association between prenatal ethanol exposure and renal malformations, it has been suggested that children with fetal alcohol syndrome (FAS) should be screened for renal anomalies. The purpose of this study was to evaluate a group of children prenatally exposed to alcohol to determine the incidence of renal anomalies and to evaluate the need for such a screening procedure.

Methods. Renal ultrasounds were performed on a total of 84 patients (68 children, 13 adolescents, and three adults). In addition to screening for malformations, renal size was studied. Data were analyzed using both chronologic and height-age as determinants of kidney size.

Patients. Of these 84 patients, 51 (61%) had FAS, and 33 (39%) had a history of prenatal ethanol exposure but did not have FAS.

Results. Three (3.6%) patients (one with FAS, two with prenatal ethanol exposure who did not have FAS) had significant renal abnormalities. This incidence was not significantly different from that found in ultrasound screening of newborns. The kidneys of children with both FAS and prenatal ethanol exposure who did not have FAS were significantly smaller than normal for both chronologic and height-age. When children were compared across chronologic ages, those with FAS had significantly smaller kidneys than those who had no evidence of FAS. After adjusting for height, the difference between these two groups was no longer significant.

Conclusions. Based on these data, children prenatally exposed to ethanol do not need to be screened for renal anomalies.
BABY-FORMULA TV ADS IN TAIWAN
Authors: L. J. F.
Published: December 2021

Taiwan will ban television advertisements for infant formula April 1 to encourage breast-feeding, which surveys found is practiced by less than 10% of Taiwan women. The Health Department said the island state's three TV stations have been ordered to stop showing the commercials. It will discourage the ads on radio and in print, where it hasn't any authority. Infant-formula producers and importers spend at least $7.7 million a year on ads. Imports account for 80% of the market, valued at $119 million annually.
Influenza B Virus Infection in Pediatric Solid Organ Transplant Recipients
Authors: Mauch Teri Jo , Myers Tim , Kashtan Clifford E. , Bratton Susan , Krane Elliot , Gentry Sharron R.
Published: December 2021

Objective. Influenza B virus causes epidemic infection in normal children, but only one case of infection in an immunocompromised solid organ transplant (SOT) recipient has been reported. Characterization of the clinical course of influenza B virus infection in pediatric SOT recipients may increase the utilization of preventive and therapeutic interventions by pediatricians caring for these immunocompromised children.

Design. Retrospective chart review of patients whose respiratory viral cultures yielded influenza B from January 1989 through March 1992.

Patients. Twelve pediatric SOT recipients with influenza B virus infection were identified. These included five renal, four hepatic, and three cardiac allograft recipients, ranging from 19 months to 17 years 9 months of age (median 6 years 2 months). The post-transplant interval ranged from 6 weeks to 4 years 6 months (average 26.7 months). No patient had been immunized against influenza. Exposure histories were documented for eight children; five of these occurred in the hospital.

Results. Clinical symptoms included fever (12/12), respiratory (11/12), or gastrointestinal complaints (8/12). Five patients had neurologic involvement; one died of uncal herniation. Ten children were hospitalized (median duration, 3 days; range, 2 to 79 days). Two patients (post-transplant interval, 3 to 8 months) required mechanical ventilation, and one of these received aerosolized ribavirin. Three children had concurrent allograft rejection.

Conclusions. Influenza B infection is potentially life-threatening in pediatric SOT recipients. We recommend annual immunization of pediatric SOT recipients, their household contacts, and health care workers. Prospective studies are needed to evaluate the efficacy of influenza vaccination in pediatric SOT recipients.
Letter to the Editor
Authors: Stevens-Simon Catherine , McAnarney Elizabeth R. , Roghmann Klaus J.
Published: December 2021

Thank you for giving us the opportunity to respond to the points raised by Drs Rees and Bach, Dr Scholl and colleagues, and Dr Lederman concerning our recent article "Adolescent Gestational Weight Gain and Birth Weight." We considered the letters, de-archived the data sets, and reran the analyses. Many points in the letters were valid and were appreciated. There is always the possibility of clerical errors and statistical omissions that should be checked for, but we found no major errors.
ANAPHYLACTIC SHOCK AFFER INSECT-STING CHALLENGE IN 138 PERSONS WITH A PREVIOUS INSECT-STING REACTION
Authors: Cvietusa Peter , Spahn Joseph , ADinoff Allen
Published: December 2021

Purpose of the Study. The goal of the study was to establish the frequency with which anaphylactic reactions reoccur after sting challenge in persons with previous insect-sting anaphylactic reactions, as well as the relation between the severity of anaphylaxis and levels of catecholamines and angiotensins.

Methods. One hundred thirty-eight patients with a history of an anaphylactic reaction and eight normals (including five patients who had been previously stung) were subjected to provocation test with the relevant insect. Blood samples were collected and assayed for epinephrine, norepinephrine, dopamine, and angiotensin I and II levels.

Findings. "Only" 39 of 138 (28%) patients with a previous insect sting anaphylactic reaction developed anaphylactic symptoms after sting challenge. Only those with a history of a severe reaction developed anaphylactic shock. No change in cardiovascular mediators or blood pressure was seen in patients with no or mild reactions, while those patients with anaphylactic shock had a mean arterial blood pressure drop of 33%. Significant increases in epinephrine, norepinephrine, and angiotensin II were observed within 5 minutes after the onset of symptoms and were strongly correlated with a drop in blood pressure. Dopamine and angiotensin I levels did not change significantly in any participants.

Reviewers' Comments. The repeat rate of systemic reactions of 28% is substantially lower than the previously reported rate of 60% (Hung KJ, et al. NEJM. 1978;299:157). Unfortunately, the present study does not provide significant information regarding the study population, particularly the time lapsed between the original and rechallenge stings. We are all aware of the associated problems of beta-blockers and anaphylaxis.
MITE ASTHMA IN CHILDHOOD: A STUDY OF THE RELATIONSHIP BETWEEN EXPOSURE TO HOUSE DUST MITES AND DISEASE ACTIVITY
Authors: Sachs Martin
Published: December 2021

When mite allergic asthmatic children are exposed to high levels of mite allergen, the number of mites in the mattress dust does not correlate with increased symptoms. The authors further suggested that other factors (eg, viral respiratory infections) are more likely to be associated with increased symptoms.
CHANGES IN THE PHARMACOKINETICS AND ELECTROCARDIOGRAPHIC PHARMACODYNAMICS OF TERFENADINE WITH CONCOMITANT ADMINISTRATION OF ERYTHROMYCIN
Authors: Kamada Alan
Published: December 2021

Erythromycin significantly alters terfenadine metabolism and causes accumulation in some individuals that is associated with altered cardiac repolarization.
TRENDS IN THE PREVALENCE OF ASTHMA HOSPITALIZATION IN THE 5- TO 14-YEAR-OLD MICHIGAN MEDICAID POPULATION, 1980 TO 1986
Authors: Sachs Martin I.
Published: December 2021

The authors suggest that large increases occurred in asthma hospitalization in the Michigan Medicaid pediatric population between 1980 and 1984. The most severely affected group were urban blacks. When all patients living in urban counties were analyzed there was only a minimal increase as compared to the total patients analyzed.
LONG-TERM PROGNOSIS OF NEAR FATAL ASTHMA. A 6-YEAR FOLLOW-UP STUDY OF 145 ASTHMATIC PATIENTS WHO UNDERWENT MECHANICAL VENTILATION FOR A NEAR-FATAL ATTACK OF ASTHMA
Authors: Kamada Alan
Published: December 2021

Smoking is associated with higher mortality in asthma and close and continuous surveillance is important for patients who have experienced a near-fatal asthma attack.
NATIONAL ASTHMA ATTACK AUDIT, 1991 TO 1992
Authors: Bell Thomas
Published: December 2021

Purpose of the Study. This study takes the newly developed guidelines for asthma management and compares them to ongoing asthma management in general practice.

Methods. A correspondence survey covering 218 general practices in the United Kingdom covered 1775 patients of all ages who had a total of 1805 attacks. Patient characteristics, place of management of attacks, and actual management were compared to recommended guidelines. The physicians from participating practices had attended a special one-half day course on the guidelines, largely derived from the British Thoracic Society and then took part in the survey for three consecutive months.

Findings. There is extensive demographic data of interest, including level of care, incidence of hospitalization, age distribution, and other parameters—too lengthy for inclusion in this review. Hospital admissions peaked (16%) in the 0-to 9-and >69-year age ranges. Twenty-nine percent had their own peak flow meters (PPM), and 34% had been issued their own asthma self-management plan. Two deaths were reported—both were moribund upon arrival for treatment. On presentation PFM readings were obtained in 82% and asthma ratings in 97%. After this great start, things began to deteriorate when we examined therapy. Nebulization was given to only 35% of patients, and steroids to 55%. A sizable proportion of patients graded as "breathless and distressed" did not receive the recommended lifesaving antiasthma treatment with nebulization (46%) and steroids (48%). The authors stress that the standards or guidelines derived from hospital care may not necessarily be applicable to general practice. Thirty-five percent of the patients were given antibiotics.
IMPROVING INFLUENZA VACCINATION RATES IN CHILDREN WITH ASTHMA: A TEST OF A COMPUTERIZED REMINDER SYSTEM AND AN ANALYSIS OF FACTORS PREDICTING VACCINATION COMPLIANCE
Authors: Randolph Christopher
Published: December 2021

A computerized reminder system is helpful in increasing influenza vaccination rates. However, the majority of patients did not respond to this system and parental concern over the vaccine side effects and asthma were the leading variables influencing compliance with the influenza vaccination.
LONG TERM EFFECTS OF A LONG-ACTING B2-ADRENORECEPTOR AGONIST, SALMETEROL, ON AIRWAY HYPERRESPONSWENESS IN PATIENTS WITH MILD ASTHMA
Authors: Chipps Bradley E.
Published: December 2021

Purpose of the Study. To investigate long term effects of long-acting β2 agonist (salmeterol) on bronchodilation and bronchoconstriction caused by methacholine (MCH).

Study Population. Twenty-four adult asthmatics (average age 25, range 19-36 yrs) who had not required any regular medication for 6 months.

Methods. Parallel double blind study where either salmeterol 50 µg twice daily or placebo was administered during an 8-week trial. A complete dose response curve for MCH was recorded on days 0, 28, 56, and 2 and 4 days after the study ended. The PC20 (concentration required for 20% drop in FEV1) was recorded. Albuterol in an aggregate dose of 400 µg/day was allowed as rescue medication.

Findings. Salmeterol caused a significant increase in FEV1 which did not change throughout the study. On the first treatment day salmeterol afforded protection against bronchoconstriction with 10-fold increase in PC20. After 4 and 8 weeks of therapy the change in PC20 returned to baseline after 4 days of washout.

Reviewer's Comments. The regular use of long-acting beta agonist leads to tolerance to its protective effect against a bronchoconstrictor stimulus, although bronchodilator properties remain unchanged. Although the mechanism is unknown, this data suggests that long-term monotherapy with beta agonist may not be optimal.
PHARMACODYNAMIC EFFECTS OF INHALED DRY POWDER FORMULATIONS OF FENOTEROL AND COLFORSIN IN ASTHMA
Authors: Kamada Alan
Published: December 2021

Fenoterol administered by inhalation of dry powder caused less tremor and hypokalemia than the MDI formulation, with similar bronchodilator response. Measurable bronchodilation was also observed with colforsin.
COUGH VARIANT ASTHMA: USEFULNESS OF A DIAGNOSTIC THERAPEUTIC TRIAL WITH PREDNISONE
Authors: Miller Betty
Published: December 2021

Cough variant asthma can range in severity from mild chronic coughing to severe explosive episodes. The diagnosis of cough variant asthma is not difficult when it is suspected. A short burst of prednisone may reverse the inflammation in the bronchi, thereby establishing the diagnosis of cough variant asthma, and therapeutically improve the patient's symptoms. A reasonable prednisone regimen of 30 mg for 7 days is suggested. Continued effective control was sustained with inhaled corticosteroids. Follow-up more than 2 years later revealed that 7 of 10 patients still used inhaled corticosteroids to control their cough symptoms and three patients became free of cough, requiring no medication.
RISK OF FATAL AND NEAR-FATAL ASTHMA IN RELATION TO INHALED CORTICOSTEROID USE
Authors: Goldsobel Alan B.
Published: December 2021

Purpose of the Study. To examine the relationship between patterns of use of inhaled beclomethasone dipropionate (50 µg/puff) and the risk of fatal and near-fatal asthma.

Study Population. A cohort of 12 301 individuals aged 5 to 54 years was identified from the residents of Saskatchewan, Canada. These were asthma patients dispensed ten or more prescriptions for drugs in common use for asthma treatment from 1978 to 1987.

Methods. A case control analysis was performed. Cases were defined as persons within the cohort who met predetermined criteria for having fatal or near-fatal asthma. These were matched with 655 controls within the cohort who had asthma, but no fatality or near-fatality. The subjects were then stratified as to their use of inhaled beclomethasone dipropionate for the 12 months prior to the fatal or near-fatal event, or index date for controls. Each person's use of inhaled beclomethasone was divided into three groups: no medication in the prior 12 months, less than 12 units in the previous 12 months, or greater than 12 units over the previous 12 months.

Findings. Of the 784 cases and controls, 269 had been dispensed inhaled beclomethasone in the prior 12 months. Of these, 232 had been dispensed less than 12 units, and only 37 had been dispensed 12 or more units. Matched odds ratio adjusted for use of other medications and number of hospitalizations for asthma showed a 1.6 times increased risk of fatal and near-fatal asthma in the group using less than 12 units of beclomethasone per year as compared to the group using none, but this did not meet statistical significance.
SHORT TERM GROWTH DURING TREATMENT WITH INHALED FLUTICASONE PROPIONATE AND BECLOMETHASONE DIPROPIONATE
Authors: Stempel David
Published: December 2021

The investigators feel that this study demonstrates that fluticasone has significantly less systemic effect than beclomethasone. This result does agree with several other articles demonstrating fluticasone's limited systemic effect while being topically very potent. The investigators state that beclomethasone had a significant effed on growth rate. They also discuss the limitations of short term growth studies. They question of whether selecting a population of children who warrant therapy with inhaled steroids (the children in this study had mild asthma) might have a different result because the growth suppressive effect of the inhaled steroid might be countered by the growth enhancing impact of improved disease status.
PREVENTION OF VIRAL-INDUCED ASTHMA ATTACKS USING INHALED BUDESONIDE
Authors: Stempel David
Published: December 2021

The authors conclude that novel approaches need to be taken to decrease the morbidity from viral induced asthma. They question whether the use of alternative delivery systems or higher doses of the inhaled steroid might have improved the outcome in the budesortide treated group.
GASTROINTESTINAL BLEEDING IN CHILDREN WITH STATUS ASTHMATICUS
Authors: Selcow Jay E.
Published: December 2021

The three cases represent the range of GI bleeding that may be observed in pediatric patients with status asthmaticus. Possible etiologies include drug use such as theophylline, corticosteroids, and beta sympathomimetics as well as stress ulceration. Since the GI bleeding occurred within 12 hours of initiating corticosteroids, it is unlikely that they alone were responsible. Stress-related peptic ulcers occur in 6 to 100% of critical care patients. Ischemia seems to be the major cause of stress ulceration. Given the time course, it seems most unlikely that stress through tissue hypoxia and ischemia played a major role in the etiology of the bleeding in the last 2 cases. Currently, the prevalence of GI bleeding in children with status asthmaticus is not known, nor have the risk factors been delineated. Although all three patients reported in this series were black, they do not indicate a propensity for GI bleeding in this ethnic group; rather, they may reflect the referral pattern to a tertiary care center.
SCHOOL FUNCTIONING OF US CHILDREN WITH ASTHMA
Authors: Randolph Christopher
Published: December 2021

These federal data suggest that enhanced risk of academic problems particularly learning disabilities are present in children with asthma especially those in poor health versus well children.
DELAYED RECOGNITION OF HUMAN IMMUNODEFICIENCY VIRUS INFECTION IN PREADOLESCENT CHILDREN
Authors: McAnelly George , Shearer William T.
Published: December 2021

The incubation period for perinatally or neonatally acquired HIV-1 infection in children may be quite variable. This study demonstrated how a prolonged disease-free state and underlying immune abnormalities may exist in older children with HIV-1 infection. Physicians caring for children must have a heightened awareness that HIV-1 infection may appear in the older child.
RISK FOR PERINATAL HIV-1 TRANSMISSION ACCORDING TO MATERNAL IMMUNOLOGIC, VIROLOGIC, AND PLACENTAL FACTORS
Authors: Church Joseph
Published: December 2021

Subgroups of HIV-infected women based upon maternal immunologic and placental characteristics had a risk of perinatal HIV transmission that varied from 7% to 71%. The impact of different risk factors for perinatal HIV vary over the course of maternal HIV infection.
CD40 LIGAND GENE DEFECTS RESPONSIBLE FOR X-LINKED HYPER-IgM SYNDROME
Authors: Levy Arden , Liu Andrew
Published: December 2021

Purpose of the Studies. Hyper-IgM immunodeficiency is characterized by recurrent bacterial infections, normal or elevated IgM, and markedly decreased IgG, IgA, and IgE. Previous research suggested that the T cells of these patients are defective in their ability to help B cells make functional antibody. CD40 ligand (CD4OL) is a membrane glycoprotein on activated T helper cells and binds the CD40 molecule expressed on B cells, and induces proliferation and immunoglobulin class switching (in conjunction with IL-4). The gene for the CD4OL has been mapped to position q26.3-q27.1 on chromosome X (same as the Hyper-IgM gene and the area of isotype switching). Several research groups sought to determine if the immunodeficiency in Hyper-IgM patients is due to defective CD4OL.

Findings. The five papers listed above document the work of different research groups that simultaneously found abnormalities in the CD4OL gene in a total of 16 patients with X-linked Hyper-IgM syndrome. Different mutations of the CD4OL gene have been discovered, including point mutations, deletions, and nonsense sequences. Mutant version of CD4OL taken from Hyper IgM patients were unable to "help" B cells in vitro. Thus, deficient CD40/CD40L interactions between B and T cells results in severely impaired immunity. Restricted CD40L gene expression to T cells may ultimately allow gene therapy as treatment.

Reviewers' Comments. A concise editorial by Jean Marx entitled "Cell Communication Failure Leads to Immune Disorder" describes this landmark research and accompanies the Spriggs article in the February 12th issue of Science (pp. 896-897). This discovery may not only lead to treatment of this disorder, but also modification of other less favorable immune responses.
CD40 LIGAND MUTATIONS IN X-LINKED IMMUNODEFICIENCY WITH HYPER-IgM
Authors: Levy Arden , Liu Andrew
Published: December 2021

Purpose of the Studies. Hyper-IgM immunodeficiency is characterized by recurrent bacterial infections, normal or elevated IgM, and markedly decreased IgG, IgA, and IgE. Previous research suggested that the T cells of these patients are defective in their ability to help B cells make functional antibody. CD40 ligand (CD4OL) is a membrane glycoprotein on activated T helper cells and binds the CD40 molecule expressed on B cells, and induces proliferation and immunoglobulin class switching (in conjunction with IL-4). The gene for the CD4OL has been mapped to position q26.3-q27.1 on chromosome X (same as the Hyper-IgM gene and the area of isotype switching). Several research groups sought to determine if the immunodeficiency in Hyper-IgM patients is due to defective CD4OL.

Findings. The five papers listed above document the work of different research groups that simultaneously found abnormalities in the CD4OL gene in a total of 16 patients with X-linked Hyper-IgM syndrome. Different mutations of the CD4OL gene have been discovered, including point mutations, deletions, and nonsense sequences. Mutant version of CD4OL taken from Hyper IgM patients were unable to "help" B cells in vitro. Thus, deficient CD40/CD40L interactions between B and T cells results in severely impaired immunity. Restricted CD40L gene expression to T cells may ultimately allow gene therapy as treatment.

Reviewers' Comments. A concise editorial by Jean Marx entitled "Cell Communication Failure Leads to Immune Disorder" describes this landmark research and accompanies the Spriggs article in the February 12th issue of Science (pp. 896-897). This discovery may not only lead to treatment of this disorder, but also modification of other less favorable immune responses.
DEFECTIVE EXPRESSION OF CD40 LIGAND IN X-CHROMOSOME LINKED IMMUNOGLOBULIN DEFICIENCY WITH NORMAL OR ELEVATED 1gM
Authors: Levy Arden , Liu Andrew
Published: December 2021

Purpose of the Studies. Hyper-IgM immunodeficiency is characterized by recurrent bacterial infections, normal or elevated IgM, and markedly decreased IgG, IgA, and IgE. Previous research suggested that the T cells of these patients are defective in their ability to help B cells make functional antibody. CD40 ligand (CD4OL) is a membrane glycoprotein on activated T helper cells and binds the CD40 molecule expressed on B cells, and induces proliferation and immunoglobulin class switching (in conjunction with IL-4). The gene for the CD4OL has been mapped to position q26.3-q27.1 on chromosome X (same as the Hyper-IgM gene and the area of isotype switching). Several research groups sought to determine if the immunodeficiency in Hyper-IgM patients is due to defective CD4OL.

Findings. The five papers listed above document the work of different research groups that simultaneously found abnormalities in the CD4OL gene in a total of 16 patients with X-linked Hyper-IgM syndrome. Different mutations of the CD4OL gene have been discovered, including point mutations, deletions, and nonsense sequences. Mutant version of CD4OL taken from Hyper IgM patients were unable to "help" B cells in vitro. Thus, deficient CD40/CD40L interactions between B and T cells results in severely impaired immunity. Restricted CD40L gene expression to T cells may ultimately allow gene therapy as treatment.

Reviewers' Comments. A concise editorial by Jean Marx entitled "Cell Communication Failure Leads to Immune Disorder" describes this landmark research and accompanies the Spriggs article in the February 12th issue of Science (pp. 896-897). This discovery may not only lead to treatment of this disorder, but also modification of other less favorable immune responses.
DEFECTIVE EXPRESSION OF T-CELL CD40 LIGAND CAUSES X-LINKED IMMUNODEFICIENCY WITH HYPER IgM
Authors: Levy Arden , Liu Andrew
Published: December 2021

Purpose of the Studies. Hyper-IgM immunodeficiency is characterized by recurrent bacterial infections, normal or elevated IgM, and markedly decreased IgG, IgA, and IgE. Previous research suggested that the T cells of these patients are defective in their ability to help B cells make functional antibody. CD40 ligand (CD4OL) is a membrane glycoprotein on activated T helper cells and binds the CD40 molecule expressed on B cells, and induces proliferation and immunoglobulin class switching (in conjunction with IL-4). The gene for the CD4OL has been mapped to position q26.3-q27.1 on chromosome X (same as the Hyper-IgM gene and the area of isotype switching). Several research groups sought to determine if the immunodeficiency in Hyper-IgM patients is due to defective CD4OL.

Findings. The five papers listed above document the work of different research groups that simultaneously found abnormalities in the CD4OL gene in a total of 16 patients with X-linked Hyper-IgM syndrome. Different mutations of the CD4OL gene have been discovered, including point mutations, deletions, and nonsense sequences. Mutant version of CD4OL taken from Hyper IgM patients were unable to "help" B cells in vitro. Thus, deficient CD40/CD40L interactions between B and T cells results in severely impaired immunity. Restricted CD40L gene expression to T cells may ultimately allow gene therapy as treatment.

Reviewers' Comments. A concise editorial by Jean Marx entitled "Cell Communication Failure Leads to Immune Disorder" describes this landmark research and accompanies the Spriggs article in the February 12th issue of Science (pp. 896-897). This discovery may not only lead to treatment of this disorder, but also modification of other less favorable immune responses.
Early Discharge of the Term Newborn: A Continued Dilemma
Authors: Britton John R. , Britton Helen L. , Beebe Susan A.
Published: December 2021

Objective. To provide the pediatric practitioner with a summary of available data regarding the appropriate time of hospital discharge of the term newborn.

Methodology. Published series on early discharge were critically reviewed.

Results. Heterogeneity and limitations of methodology and study design substantially limit conclusions that may be drawn from published studies.

Conclusion. Early discharge recommendations of the American Academy of Pediatrics remain appropriate, and decisions regarding the timing of discharge of the well term newborn should be individualized and made by the practitioner based upon the medical, social, and economic aspects of each case.
Functional Outcome After Pediatric Head Injury
Authors: Greenspan Arlene I. , MacKenzie Ellen J.
Published: December 2021

Objectives. To examine the consequences of head injury and the medical, economic, and sociodemographic factors affecting functional status 1 year after injury.

Methods. A follow-up was conducted on 95 children (aged 5 to 15) 1 year after they were hospitalized for head injury. Parents were interviewed by phone concerning their child's preinjury and current health status, and the family's economic and social resources during the 1 year postinjury. Inpatient medical records were reviewed to obtain information regarding the characteristics of the injury.

Results. We found that study children were more likely than children from the general population to have limitations in physical health, behavioral problems, and to be enrolled in a special education program. These findings were true for all levels of head injury severity, although children with severe head injuries (Abbreviated Injury Scale 5) were more likely to demonstrate these functional limitations than were children with less severe injuries (Abbreviated Injury Scale 2, 3, 4). After controlling for head injury severity, we found that the poorer outcomes were associated with poverty, preinjury chronic health problems, and lower extremity injuries.

Conclusions. The large proportion of children who demonstrated functional limitations underscores the importance of evaluating all children hospitalized with head injuries for functional limitations and providing rehabilitation and social services when needed.