Tuesday, January 29, 2013

How to Keep Your Child Safe from Cold and Flu

How to Keep Your Child Safe from Cold and Flu
Parents hate it when their children get sick. The children become cranky, weak and sad. They miss out on important things such as school, time with family and other social obligations. As a parent, you get worried and have to interrupt your normal day to take care of your child’s needs. It is, therefore, much better to make sure that your children are protected from this unfortunate situation. Here are a few tips on how to keep them safe from colds and flu.
Keep Your Hands Clean
One of the most effective ways of keeping your children and family members safe from flu and cold viruses is to ensure that they always keep their hands clean. It is important that you teach your children, from a very early age, how to properly wash their hands.
Washing hands is not just a matter of getting your hands wet. Use warm water and soap to gently, but thoroughly scrub the palm, between the fingers, back of the hand and even under the nails for approximately 20 seconds.  A fun way of helping your children remember, how to wash hands effectively, is by making them sing “Happy Birthday” twice while they scrub their hands before rinsing.
Make sure that they know they need to wash their hands before eating, after using the loo, after handling dirt or pets and after coughing. Your child’s care givers and sitters also need to be taught that they need to keep their hands clean too, for the child’s sake.

Disinfect Your Child’s Environment
Children can be all over the place. They love to explore their environment and can be quite efficiant at it, too. A child can touch an excess of 300 surfaces in a mere 30 minutes. If one of these has germs, it means that they can very easily spread these germs all over the house in a very short time. It is important to make sure that their environment is as germ free as possible.
A very effective way of doing so is using disinfectant spray right after you have cleaned your house. Spray makes it easier to reach those hard to reach surfaces. A cheaper alternative is to use a bleach solution mixed with water. For those keen on natural alternatives, you can use vinegar, borax or tree tea oil.
Make sure you disinfect all those surfaces that are commonly touched like doorknobs, light switches, and telephone mouthpieces. Also, ensure that your dishes are properly washed with soap and water too. Do not share spoons, forks and knives without washing them first.
Avoid Exposure
Before you let your child travel or visit friends or relatives, find out whether where they are going is healthy. If they are having friends over, or travelling to a friend’s house for a playdate, try your best to find out if the children they will make contact with are not suffering from colds, flu and other communicable diseases. If your child is ill, don’t let them expose friends to germs. Keep them at home with proper rest and medication until they become better.

Healthy Habits for Healthy Lives
Generally, a healthy child will be less likely to fall ill from any kind of sickness. It is important that you introduce healthy habits for children in your home as early as possible. From teaching your children how to keep clean, getting the right kind of exercise, eating right to getting enough sleep. If your child is young, please make sure that you breast feed them for as long as possible. By doing these things, you build your child’s immune system, making them naturally able to fight off disease.
Visit Your Doctor
If your child gets sick, please make sure that you visit the doctor. It is easy to think that you can self-prescribe medication for your child, however do not do so. For children, if symptoms persist, please do not hesitate to rush them to a trusted pediatrician. They are more sensitive to illness and, as a result, need better care and monitoring.

Who let the dogs out ? The medical laboratory, that's who !

Dogs have an olfactory capacity that is more than 100 times that of humans, and that stool from patients with Clostridium difficile infection has a unique odor due to P-cresol, a phenolic compound fermented by the bacteria.
Some nurses, laboratory technicians, and physicians have been able to make a diagnosis of C. difficile infection on the basis of this odor.
The study by physicians in The Netherlands used a Beagle dog trained to recognize the unique odor of stool containing C. difficile toxin. Testing of stool samples showed recognition of positive tests in 30/30 (100% sensitivity) and negative tests in 270/270 (100% specificity).
These results are superior to all existing tests for C. difficile infection.
Comments: We NEVER get a screening test with 100 % sensitivity & 100 % specificity, so if we can train dogs right, this is the way to go!!

Thursday, January 24, 2013

Honey as a Cough Suppressant in Children: Does It Work?

Effect of Honey on Nocturnal Cough and Sleep Quality: A Double-Blind, Randomized, Placebo-Controlled Study

Cohen HA, Rozen J, Kristal H, et al

Pediatrics. 2012;130:465-471

Honey as a Cough Suppressant

The use of over-the-counter (OTC) cough and cold medications is discouraged by professional societies and the US Food and Drug Administration. Home remedies, such as honey, are inexpensive and could be safe alternatives for the treatment of cough. Cohen and colleagues conducted a trial in Israel, enrolling children at 6 community clinics during 2009. The goal of this study was to compare the effects of a single nocturnal dose of 1 of 3 different honey products, with placebo, on overnight cough and sleep symptoms for children with upper respiratory infections.

Study Summary

The children in the study were 1-5 years old and had what was believed to be an uncomplicated upper respiratory infection. Children with asthma, pneumonia, sinusitis, or allergic rhinitis were excluded from the study. Outcomes were measured with pre- and postintervention questionnaires containing 5 items that assessed the child's cough and degree of sleep difficulty the night before and the night of the intervention. Children were enrolled if their scores on the preintervention questionnaire were of sufficient severity.
The 3 different honey treatments included eucalyptus honey, labiatae honey, and citrus honey. The placebo compound was made from dates, and it was also brown and sweet. On the night of the intervention, parents gave 10 g of the allocated compound 30 minutes before the children went to sleep. On the next day, study personnel contacted the family by telephone to complete the postintervention questionnaire. Parents were asked about the following:
  • Frequency of nocturnal cough the previous night;
  • Severity of the cough;
  • How bothersome the cough was;
  • The degree to which the cough affected the child's sleep; and
  • The degree to which the cough affected the parents' sleep.
The primary outcome was the change in the frequency of the nocturnal cough from pre- to postintervention assessments. The study enrolled 300 children with upper respiratory infections, and 89.7% completed the protocol. The median age of the children was 29 months, and 54% were boys. For most of the assessment items, there were no differences among the 3 different honey extracts. Each of the honey extracts improved symptoms compared with the placebo extract. Cohen and colleagues concluded that honey given at bedtime was more effective than placebo in reducing the frequency and severity of nighttime cough. They suggest that honey could be used as a safe and effective cough suppressant for children 1 year of age and older.


Honey has many potential medicinal benefits, including antioxidant activity. Histograms created by the investigators show that the postintervention scores were lower for every group, suggesting a potential benefit of just being in the study, or a temporal improvement of symptoms. However, improvement was universally much greater for the honey extracts, by as much as 20%, compared with the placebo extract. The American Academy of Pediatrics (AAP) does not recommend honey for patients younger than 1 year of age because of the potential risk for botulism. The AAP has produced a handout that can be shared with families, and that details several safe alternatives for alleviating cold symptoms in children, including honey. When considering the relatively low cost of honey (compared with OTC cough and cold medications) and concerns over the vasoactive agents in OTC cough and cold preparations, honey sure seems to be an attractive option.

Wednesday, January 23, 2013

Do Inhaled Steroids Stunt a Child's Growth?

Effect of Inhaled Glucocorticoids in Childhood on Adult Height

Kelly HW, Sternberg AL, Lescher R, et al

N Engl J Med. 2012;367:904-912

Steroids and Growth Velocity

Prepubertal children treated with inhaled glucocorticoids for asthma show an initial reduced growth velocity.[1] When these observations were first made, it was not known whether the initial drop in growth velocity would influence eventual adult height. Now, Kelly and colleagues provide data from long-term follow-up of children enrolled in the Childhood Asthma Management Program (CAMP), one of the most comprehensive studies to evaluate the effects of inhaled glucocorticoids for the treatment of asthma in children.

Study Summary

The double-blind, placebo-controlled study enrolled 1000 children, aged 5-13 years, with mild-moderate asthma, from 1993 to 1995. Children were assigned to 1 of 3 groups. One group received 200 µg of budesonide twice daily. Another group received 8 mg of nedocromil inhaled twice daily, and the third group received placebo. The height and weight of the patients were measured at 6- to 12-month intervals over the following 12 years. The adult heights reported in this study were obtained at a mean age of 24.9 years. The primary analysis of interest was a regression model to compare the mean adult height of children treated with budesonide with the height of those treated with nedocromil or placebo, accounting for 8 covariates including age, race or ethnicity, sex, enrollment site, height at trial entry, duration of asthma at enrollment, severity of asthma at enrollment, and whether the patient had positive skin testing to allergens.
They specifically evaluated growth velocity during the first 2 years of the trial. They also evaluated the overall glucocorticoid dose exposure while adjusting for additional demographic characteristics, including cigarette smoke exposure in utero and total prednisone exposure from enrollment until adult height was reached. The investigators were able to obtain adult height measurements on 943 children (slightly more than 90% of the original enrollees). In the primary analysis, the children who took budesonide were 1.2 cm shorter on average compared with the placebo group (171.1 cm vs 172.3 cm). The mean adult height of patients treated with nedocromil was 172.1, a value not significantly different from the placebo group. A greater negative effect on height was observed in women. Girls who took budesonide were an average of 1.8 cm shorter than girls who took placebo. Boys who received budesonide were 0.8 cm shorter than those who received placebo.
The negative effects on adult height were greater for children who were younger when they enrolled in the trial, but these differences were not significant. The investigators found that the difference in growth velocity occurred primarily in prepubertal children who were 5-10 years of age at enrollment. The evaluation of cumulative dose also demonstrated a dose-response effect. Patients who received higher daily doses of inhaled steroids during the treatment had a correspondingly greater reduction in their average adult height. Other factors associated with a lower adult height were Hispanic ethnicity and female sex as well as skin test reactivity and vitamin D insufficiency. Of interest, cumulative prednisone exposure during the treatment phase was not associated with differences in adult height. The height difference ultimately displayed by the children resulted from differences in their growth velocity in the first 2 years after trial enrollment. Kelly and colleagues concluded that this difference persisted into adulthood, but it was not progressive. They suggested that the well-established benefits of inhaled steroid therapy for prevention of asthma exacerbations should be weighed against potential reductions in adult height.


This study will no doubt come as a disappointment to the generation of pediatricians who have relied on inhaled corticosteroids as the basis for asthma control. As a class, inhaled corticosteroids have consistently demonstrated superior efficacy in controlling asthma symptoms. However, this very comprehensive evaluation suggests that the improved asthma control may indeed come at a price. It is encouraging to find that children treated with inhaled steroids after age 11 years did not experience a significant effect on adult height. For the adolescent age group, therefore, there appear to be few concerns associated with using inhaled corticosteroids, at least in relation to growth. Kelly and colleagues suggest that one way to mitigate the potential effects of inhaled steroids on growth would be to use the minimum effective dose for every patient. These data provide strong evidence that reducing inhaled steroid dose, when possible, is important to consider.

Wednesday, January 09, 2013

What's Statophobia ?

A fascinating condition that most doctor's suffer from, as explained in this excellent email from Dr Ronald E LaPorte
Supercourse Newsletter
6 January 2013

Dear Friends


Stataphobia is a devastating disease which primarily afflicts scientists
world wide. It renders scientists unresponsive,  rejects their articles
and prevents  tenure. With the   Library of Alexandria we plan to cure
this horrible malady.  Please forward this to your friends and students
who now, or in the future will suffer from this debilitating disease.

Stataphobia is defined as a rapidly progressive disorder of scientists
caused by statistical ignorance and fear

Virtually all scientists across the world suffer from this.   I am a
Stataphobic.  Of the 500 articles I have published  in 300 my research
design and statistics were questioned  Almost every Nobel Prize winner,
professor, academic has had this disease. Darwin, Copernicus, and Einstein
had bouts of severe stataphobia. Stataphobia is the primary risk factor
for the death of scientific articles  and NIH Grants, it must be stopped

But every now and then I feel so insecure,
I know that I just need you like, I've never done before.( Beatles)

All of us in research  have symptoms of design insecurity  and need
research methods experts in oh so many ways  .  I am fortunate as 4 floors
down are friends in statistics. However, in research limited universities
and countries around the world, the only research expert might be half a
country away, a major determinant of Stataphobia.

The Cure to Stataphobia:  BA Superhelp desk

Help me get my feet back on the ground,
Won't you please, please help me? (to plan and analyze my research???)
(Beatles and me)

To prevent Stataphobia, every scientist should have your own virtual
research counselor.  A sure way to cure Stataphoia is to provide
counselors to show the irrationality of our fear of Stats.  This will lead
to enormous psychological improvement and better publications. The Library
of Alexandria SuperHelp desk will boost scientific productivity by giving
every scientist a virtual research methods counselor, and will help
prevent the global epidemic of Stataphobia.

Only 3% of the articles in international journals come from developing
countries, despite the fact that 25% of the researchers are from
developing countries and 80% of the people.  As we have indicated, over
80% of the time articles are rejected it is because of research methods
problems.  The reality is that no matter how good one’s hypothesis is from
any place in the world an article will never be published unless the
research methods are adequate. The BA SuperHelp desk can help stamp out
this ugly disease.

The BA SuperHelp virtual desk  will provide all of you a research methods
hotline.  Over 20 gray/no hair research experts have banded together to
help provide advice.  We will need other experts such as those having a
significant publication record, or statistical training please join the
Stataphobia vaccination team. We decided to start our effort in the
bastion of civilization, Egypt, and set up the help desk for researchers
in Egypt to see how it will work in February. In Egypt we of course have
the Library of Alexandria leading the effort. We have a research expert,
Eman Eltahlawy who has taken the lead.  We will see how our efforts work
in Egypt and then expand to other countries once we see the flow of

The door to the prevention of Stataphobia:

Our door consists of 12 areas where there are likely going to be
questions, e.g. bias, power calculation, sampling, etc. We have a
Supercourse lecture and a wiki explanation.

It must be fate as the “ Door to Research methods” = LaPorte 2 RESRCH

This trial period is designed to provide us an idea as to how much traffic
we will receive.
From Euclid to BA SuperHelp desk

Tuesday, January 08, 2013

Headaches in Children Appear Unrelated to Vision Problems

Medscape Medical News from the:

  • American Academy of Ophthalmology (AAO) 2012 Annual Meeting
  • Vision and other eye problems are not linked to recurring headaches in children, even if the headaches strike while the child is doing schoolwork or other visual tasks, according to a study presented at the American Academy of Ophthalmology (AAO) and Asia-Pacific Academy of Ophthalmology 2012 Joint Meeting.
    The investigators conducted a retrospective review of 158 children 18 years old and younger who presented to a pediatric ophthalmology practice complaining of headaches between 2002 and 2011.
    "Our idea was to compare children for whom glasses were indicated to those who did not need glasses, and see if the headaches got better [with corrected vision]…. Ultimately, those 2 groups had the same outcomes. Whether or not the child had a refractive error that warranted correction, the presence or absence of headache remained the same. From this, we concluded that refractive error is not playing a large role in pediatric headaches," said Zachary Roth, MD, from the Albany Medical Center, New York, who presented the findings.
    "This information should be passed along to paediatricians," he added.
    All of the children had received complete eye exams by the clinic's ophthalmologists, and the results were compared with their previous medical records (eye exams and other medical care).
    No significant correlation was found between the presence of headache and the need for vision correction. For just over 75% of the children, eye health and vision test results remained normal or unchanged from earlier exams, Dr. Roth reported.
    Children who already wore glasses were not found to require new prescriptions at the time they presented with headaches. Although 14% reported that their headaches occurred while doing visual tasks such as homework, and 90% reported visual symptoms associated with their headaches, the researchers determined that a need for vision correction was not a significant factor.
    Approximately 30% of the children had ophthalmologic conditions that surpassed the need for simple vision correction, including strabismus, amblyopia, and other, more serious conditions. A family history of migraine was present in 17%.
    Most headaches resolved over time. By parental report, 76.4% of all subjects improved, including those with refractive correction (71.9%) and those without new prescriptions (78.2%), for an insignificant difference between these 2 groups of P = .38. The study did not assess the actual cause of the headaches.
    Similarly, children who received new prescriptions were not more likely than others to have resolution of their headaches, Dr. Roth reported.
    Parents Can Be Reassured
    "We hope our study will help reassure parents that in most cases their children's headaches are not related to vision or eye problems, and that most headaches will clear up in time," he said.
    Arlene V. Drack, MD, the Ronald V. Keech, MD, Associate Professor in Ophthalmic Genetics at the University of Iowa in Iowa City, commented that the findings "mirror what we see in practice, and that is that parents assume a child with headache must need glasses.
    "In my own practice, if a child with headache has any degree of refractive error I give him or her the glasses. Otherwise, the parents will keep bringing them back," she said. "Now, we can reference this study, showing evidence that it is very unusual that the need for glasses is the cause of headaches."
    Paul Joseph Rychwalski, MD, of the Cleveland Clinic, Ohio, agreed. "This study confirms what we know anecdotally. It dispels an urban myth."
    Dr. Roth, Dr. Drack, and Dr. Rychwalski have disclosed no relevant financial relationships.
    American Academy of Ophthalmology (AAO) and Asia-Pacific Academy of Ophthalmology 2012 Joint Meeting. Abstract #PO461. Presented November 12, 2012.
    Comment: Given the frequency of headaches in children, this is a valuable study. However given the lack of routine vision screening in India, and the high incidence of refractive errors requiring spectacles, it is still a good idea to get a vision assessment done for any child coming to us with headaches, even if they are not necessarily connected.

Monday, January 07, 2013

Menactra (Meningococcal Conjugate Vaccine - MCV) safe in infants

Meningococcal Conjugate Vaccine Appears Safe in Infants

Emma Hitt, PhD
Nov 14, 2012
Quadrivalent meningococcal conjugate vaccine (MenACWY-D;Menactra, sanofi pasteur) appears to be safe and immunogenic when given as a 2-dose series in infants at the age of 9 months and 1 year, according to pooled data from 3 randomized trials.
L. Miriam Pina, MD, and colleagues from sanofi pasteur in Swiftwater, Pennsylvania, report their findings in an article published in the November issue of the Pediatric Infectious Disease Journal.
According to the researchers, MenACWY-D was licensed in the United States in 2005 to prevent meningococcal disease caused by Neisseria meningitidis serogroups A, C, Y, and W-135 in teenagers and adults. A second vaccine (MenACWY-CRM; Menveo, Novartis Vaccines and Diagnostics) is also currently indicated for the prevention of invasive meningococcal disease and is approved for children and adults between the ages of 2 and 55 years.
"The license [for MenACWY-D] was extended to children aged 2–10 years in 2007 and extended again in 2011 to infants aged 9 months and older based, in part, on results from 3 phase III studies presented herein," the authors note.
To further evaluate the safety, data from these 3 trials conducted between September 2006 and January 2009 were assessed. One study enrolled 1257 participants, another study enrolled 2289 participants, and a third study enrolled 1378 participants.
At 30 days after vaccination, immunogenicity, as measured by assays of human complement titer levels (titers ≥1:8), was demonstrated in between 86.4% and 100% of children receiving 2 doses of the vaccine at ages 9 and 12 months. A titer ≥1:4 to each serogroup was achieved by more than 91% of vaccinated children.
In addition, the vaccine did not appear to interfere with the measles, mumps, rubella, and varicella or heptavalent pneumococcal conjugate vaccines, with between 81% and 98% of participants receiving concomitant vaccinations achieving protective responses.
Antipneumococcal antibody levels were decreased when the meningococcal vaccine was given with the heptavalent pneumococcal conjugate vaccine but remained protective for all serotypes by enzyme-linked immunosorbent assay (98% - 100%, ≥0.35 μg/mL) and opsonophagocytic assay (99% - 100%, ≥1:8).
According to the authors, adverse events were generally mild and similar across groups. "Injection-site and systemic events were similar to those of currently licensed, routinely administered pediatric vaccines," they add. Of the participants, between 23.3% and 30.1% reported erythema and between 10.1% and 16.2% reported swelling. Most injection-site reactions were reported within 3 days of the vaccination and were mild and transient.
Serious adverse events were reported in between 3% and 5% of participants receiving MenACWY-D, but they were also reported in 2% and 4% of control patients. In the 3 studies combined, 4 serious adverse events were considered related to the study vaccine: insulin-dependent diabetes mellitus, respiratory distress, and 2 cases of febrile seizures.
"In summary, MenACWY-D offers the broad protection of a quadrivalent vaccine among children 9–23 months of age when administered as a 2-dose schedule, 3 months apart," Dr. Pina and colleagues conclude. "This schedule can protect infants with fewer doses than a classic 3+1 infant schedule, and it minimizes the risk of interference and the difficulties associated with the introduction of another vaccine into an already crowded infant vaccination schedule."
Independent commentator Doug Campos-Outcalt, MD, from the University of Arizona College of Medicine in Phoenix, told Medscape Medical News that the findings support previous data showing the safety with this vaccine, but the "numbers in the study are not enough to detect rare serious adverse events."
Dr. Campos-Outcalt pointed out that it remains to be determined whether there are rare serious adverse events, noting that "when the target disease is so rare, the issue of safety becomes paramount."
"At the moment, meningococcal vaccines are recommended only for high-risk infants," he added.
This research was funded by sanofi pasteur Inc, which employs and authors. Dr. Campos-Outcalt has disclosed no relevant financial relationships.
Pediatr Infect Dis J. 2012;31:1173-1183. Full text
Comment: This study has significant relevance to India. Why? Because Menactra has just been launched a couple of days back (Jan 2013) officially by Sanofi Pasteur in India. It is at present a vaccine of limited potential, given that IAP recommends it for 'high risk' group of children only. Also given that this is an expensive vaccine (around 4,500 to 5,000 Rs.), the uptake is likely to be limited at the present point of time. However, it would be of benefit to travelers to the African sub - saharan 'meningitis belt', and to children who have an immunodeficiency, and also during an epidemic situation, that occurs every 3-5 years in many places across the country including Delhi. I agree with the IAP that at present this vaccine is NOT meant for routine use in our country. It is also pertinent to note that we already have the Meningococcal Polysaccharide Vaccine (MPV- Quadrimeningo) which is safe & quite effective in children above the age of 2 years, and far cheaper too.