Rashmi Ranjan Das

Probiotics for allergic respiratory diseases – Putting it into perspective

Singh M, Das RR. Probiotics for allergic respiratory diseases – Putting it into perspective. 
Pediatr Allergy Immunol 2010: 21: e368–e376.
© 2009 John Wiley & Sons A/S

The Effect of Prophylactic Antipyretic Administration on Post-Vaccination Adverse Reactions and Antibody Response in Children: A Systematic Review

Background Prophylactic antipyretic administration decreases the post-vaccination adverse reactions. Recent study finds that they may also decrease the antibody responses to several vaccine antigens. This systematic review aimed to assess the evidence for a relationship between prophylactic antipyretic administration, post-vaccination adverse events, and antibody response in children. Methods A systematic search of major databases including MEDLINE and EMBASE was carried out till March 2014. Randomized controlled trials (RCTs) comparing prophylactic antipyretic treatment versus placebo post-vaccination in children ≤6 years of age were included. Two reviewers independently applied eligibility criteria, assessed the studies for methodological quality, and extracted data [PROSPERO registration: CRD42014009717]. Results Of 2579 citations retrieved, a total of 13 RCTs including 5077 children were included in the review. Prophylactic antipyretic administration significantly reduced the febrile reactions (≥38.0°C) after primary and booster vaccinations. Though there were statistically significant differences in the antibody responses between the two groups, the prophylactic PCM group had what would be considered protective levels of antibodies to all of the antigens given after the primary and booster vaccinations. No significant difference in the nasopharyngeal carriage rates (short-term and long-term) of H. influenzae or S. pneumoniae serotypes was found between the prophylactic and no prophylactic PCM group. There was a significant reduction in the local and systemic symptoms after primary, but not booster vaccinations. Conclusions Though prophylactic antipyretic administration leads to relief of the local and systemic symptoms after primary vaccinations, there is a reduction in antibody responses to some vaccine antigens without any effect on the nasopharyngeal carriage rates of S. pneumoniae & H. influenza serotypes. Future trials and surveillance programs should also aim at assessing the effectiveness of programs where prophylactic administration of PCM is given. The timing of administration of antipyretics should be discussed with the parents after explaining the benefits & risks.

Vitamin d supplementation for the treatment of acute childhood pneumonia: a systematic review.

Background. Studies have found an increased incidence of vitamin D deficiency in children with pneumonia; however, there is no conclusive data regarding the direct effect of vitamin D supplementation in acute pneumonia. Methods. A comprehensive search was performed of the major electronic databases till September 2013. Randomized controlled trials (RCTs) comparing treatment with vitamin D3 versus placebo in children ≤5 years old with pneumonia were included. Results. Out of 32 full text articles, 2 RCTs including 653 children were eligible for inclusion. One trial used a single 100,000 unit of oral vitamin D3 at the onset of pneumonia. There was no significant difference in the mean (±SD) number of days to recovery between the vitamin D3 and placebo arms (P = 0.17). Another trial used oral vitamin D3 (1000 IU for <1 year and 2000 IU for >1 year) for 5 days in children with severe pneumonia. Median duration of resolution of severe pneumonia was similar in the two groups (intervention, 72 hours; placebo, 64 hours). Duration of hospitalization and time to resolution of tachypnea, chest retractions, and inability to feed were also comparable between the two groups. Conclusions. Oral vitamin D supplementation does not help children under-five with acute pneumonia.

Probiotics as additives on therapy in allergic airway diseases: a systematic review of benefits and risks.

Background. We conducted a systematic review to find out the role of probiotics in treatment of allergic airway diseases.  Methods. A comprehensive search of the major electronic databases was done till March 2013. Trials comparing the effect of probiotics versus placebo were included. A predefined set of outcome measures were assessed. Continuous data were expressed as standardized mean difference with 95% CI. Dichotomous data were expressed as odds ratio with 95% CI. P value < 0.05 was considered as significant. Results. A total of 12 studies were included. Probiotic intake was associated with a significantly improved quality of life score in patients with allergic rhinitis (SMD −1.9 (95% CI −3.62, −0.19); P = 0.03), though there was a high degree of heterogeneity. No improvement in quality of life score was noted in asthmatics. Probiotic intake also improved the following parameters: longer time free from episodes of asthma and rhinitis and decrease in the number of episodes of rhinitis per year. Adverse events were not significant. Conclusion. As the current evidence was generated from few trials with high degree of heterogeneity, routine use of probiotics as an additive on therapy in subjects with allergic airway diseases cannot be recommended.

Utility of telemedicine for children in India

ObjectiveTo show utility of telemedicine to children in Indian subcontinent.MethodsRetrospective analysis of data on 306 consecutive patients (age range 0–15 yr) managed between yr 2005–2008 in telemedicine centre of a tertiary care hospital in North India. The patient consultation were conducted using two customized soft wares — Televital and Sanjeevani. Data was extracted on a predesigned Performa.ResultsThe data included clinical details, investigations and radiological images. Ten percent of children were critically ill and could not have been in a position to be transported safely. Twelve percent of the consultations resulted in videoconferencing. There was a paucity of feedback back and follow up of these consultations.ConclusionIt is possible to provide e-health care through telemedicine to children in Indian rural and semi-urban setting. The e-health can be extended to critically ill children including newborns on a restricted basis.

Four years of experience of telemedicine for paediatric care in three Punjab hospitals, North India: achievements and lessons

Children in India constitute a very high risk group from mortality and morbidity due to lack of specialised healthcare. Remote care of paediatric patients by offsite specialists using telemedicine technology is a highly potential solution for coping up with the shortage of specialists in Indian subcontinent. We at a tertiary care teaching hospital in North India assessed the application of telemedicine services for diagnosis and management of paediatric illnesses, through prospective analyses of electronic databases over 4 years. The age groups covered were from newborn up to children of 15 years of age. The outcomes assessed were: feasibility, diagnostic possibilities, management, outcomes, referral and mean costs per patient. The results were as follows: major consultations involved children <5 years age, with neonates contributing to 5.5% of the total consultations. The major system-related problems were: gastrointestinal, respiratory, neurological, infectious and haematological. Referral was advised in 14.3% of cases. Ten percent of children were critically ill and could not have been in a position to be transported safely. Videoconferencing was done in 21.4% patients. There was a paucity of feedback and follow up of these consultations (12% of the total). The total savings for all the consultations per child was ≈1000 Indian rupees (approximately US

Treatment of pseudomonas and Staphylococcus bronchopulmonary infection in patients with cystic fibrosis.

22) leaving behind the telemedicine consultation charges. To conclude, telepaediatrics in India is still in its fetal stage. The hurdles and medico-legal issues need to be addressed before the telepaediatrics service is widely accepted in India.

Zolendronate in osteogenesis imperfecta.

The optimal antibiotic regimen is unclear in management of pulmonary infections due to pseudomonas and staphylococcus in cystic fibrosis (CF). We systematically searched all the published literature that has considered the evidence for antimicrobial therapies in CF till June 2013. The key findings were as follows: inhaled antipseudomonal antibiotic improves lung function, and probably the safest/most effective therapy; antistaphylococcal antibiotic prophylaxis increases the risk of acquiring P. aeruginosa; azithromycin significantly improves respiratory function after 6 months of treatment; a 28-day treatment with aztreonam or tobramycin significantly improves respiratory symptoms and pulmonary function; aztreonam lysine might be superior to tobramycin inhaled solution in chronic P. aeruginosa infection; oral ciprofloxacin does not produce additional benefit in those with chronic persistent pseudomonas infection but may have a role in early or first infection. As it is difficult to establish a firm recommendation based on the available evidence, the following factors must be considered for the choice of treatment for each patient: antibiotic related (e.g., safety and efficacy and ease of administration/delivery) and patient related (e.g., age, clinical status, prior use of antibiotics, coinfection by other organisms, and associated comorbidities ones).

Nitazoxanide in Acute Rotavirus Diarrhea: A Randomized Control Trial from a Developing Country

Zolendronate is a newer intravenous bisphosphonate (BP) used in treatment of osteogenesis imperfecta (OI). Brown and Zacharin have earlier reported comparable efficacy of zoledronic acid to pamidronate in OI and related disorders. We report the short-term safety and efficacy of Zolendronate in younger children with OI. A retrospective analysis was performed on children treated with zolendronate for moderate to severe OI in last 3.5 years in the Genetic Unit of the Department of Pediatrics. None of them had previously received pamidronate. The charts were reviewed for type of OI, DEXA (z-score), subjective improvement, reduction in number of fractures and side-effects. All patients received zolendronate (ZoleTrustTM, Panacea Pharmaceuticals, Gaithersburg, MD) 2 mg (<6 months) or 4 mg (>6 months) and this was repeated every 3-4 months. Calcium supplementation was given simultaneously. Those with incomplete data or who had received other BP previously were excluded. Statistical analyses were performed using Wilcoxon Signed Ranks test. Ten patients fulfilled the eligibility criteria. The age range was 2 weeks to 7 years (median 3 years) and M:F ratio was 1.5:1. The OI types based on clinical findings were: type III (n = 7), VII (n = 1), IV (n = 1), and I (n = 1). The duration of therapy was 1-3.5 years and compliance was good. All children had low bone mineral density in the lumbar spine, with z-scores ranging from -3.86 to -7.28. Except for one patient, the mean bone mineral density improved markedly, by 33.12 ± 9.42% per year, and the mean z-score improved from -5.04 ± 0.78 to -3.45 ± 0.72 (p = 0.02). The incidence of fractures decreased from 4.32 ± 0.78/year before treatment to 2.63 ± 0.84/year during treatment (p = 0.01). The patient who did not show improvement was a 1.5 year-old boy with type III OI. He was on zolendronate for 1 year and also had developmental delay. Side-effects occurred in four patients (40%) and were flu-like symptoms (33%) and myalgia (7%). These were transient and noted only during infusion. No clinical problems due to hypocalcemia were noted. A cheaper brand of zoledronate was used because of financial constraints. Within its limitations, this retrospective analysis showed that use of zolendronate is beneficial in 90% of patients in the form of reduced fracture rate and increase in bone density. In present study, significant response to zoledronate was observed though the children were relatively younger (median 3 years) compared to the previous study (median age of patients with OI 7.46 years). A longer duration of therapy may be warranted in patients who do not show significant benefit at 1 year assessment, before considering alternative therapy.

Treatment of Severe Community-Acquired Pneumonia with Oral Amoxicillin in Under-Five Children in Developing Country: A Systematic Review

Background. Acute diarrhea is one of the leading causes of childhood mortality, with rotavirus being an important pathogen. Nitazoxanide, an antiparasitic agent, has been shown to inhibit rotavirus. Objective. This double-blind, randomized trial was designed to study the role of nitazoxanide in acute rotavirus diarrhea. Methods. Of 174 children (12 months to 5 years) with acute diarrhea, 50 rotavirus positive cases were randomized. The intervention group received syrup nitazoxanide twice daily (100 mg in 12–47 months, 200 mg in ≥4 yr) for 3 days along with standard treatment of diarrhea. Duration of diarrhea was the primary outcome measure. Results. The median duration (hrs) of diarrhea (54 versus 80; 95% CI: –26 [–13.2 to –38.8]) and hospitalization (68 versus 90; 95% CI: –22 [–12.98 to –31.02]) was significantly shorter in the nitazoxanide group. No significant difference was seen in the median duration (hrs) of fever or vomiting or the proportion of children requiring parenteral rehydration. There was no report of any adverse events. Conclusions. Oral nitazoxanide is effective and safe in the management of acute rotavirus diarrhea in Indian children (CTRI REF/2016/10/012507).