Double dose <Emphasis Type="Italic">versus</Emphasis> standard dose hepatitis B vaccine in HIV-infected children: <Emphasis Type="Italic">A randomized controlled trial</Emphasis>

Objective

To compare the efficacy of double dose (20 μg) with standard dose (10 μg) of hepatitis B vaccine in HIV-infected children.

Methods

Unvaccinated HIV-infected children were randomized to receive 3 doses of double dose (N=27) or standard dose (N=28) of recombinant Hepatitis B vaccine. Anti-HBs antibody titres were measured 3 mo after the last dose. An antibody titre ≥10 mIU/mL 12 weaks after the third dose was considered as serporotection.

Result

Seroprotection was achieved by 17 (60.7%) children in standard dose group against 20 (74%) in the double dose group [RR (95%CI) 0.8 (0.17-1.7); P=0.29]. CD4 count < 500 cells/mm3 was significantly associated with lower rates of seroprotection.

Conclusion

Double dose of hepatitis B vaccine does not seem to provide any advantage when compared to standard dose in HIV-infected children.

     

Light-emitting diodes <Emphasis Type="Italic">versus</Emphasis> compact fluorescent tubes for phototherapy in neonatal jaundice: <Emphasis Type="Italic">A multi-center randomized controlled trial</Emphasis>

Objective  

To evaluate whether light-emitting diode (LED) phototherapy is as efficacious as compact fluorescent tube (CFT) phototherapy for the treatment of non-hemolytic jaundice in healthy term and late preterm neonates.     

Controversy of Single <Emphasis Type="Italic">versus</Emphasis> Staged Management of Anorectal Malformations

Anorectal malformations’ (ARMs) management has taken strides over the past few decades. The advent of Posterior sagittal anorectoplasty (PSARP) and its acceptance by most people across the globe as standard procedure has given way to a debate of single vs. three-staged repair. After initial hesitancy and lot of skepticism, single-staged repair has very well established its role because of its advantages over the staged procedure. There is enough evidence which suggests that single-staged repair has got equally good outcome as that of staged repair (if not better). Further, one-staged repair offers advantages of lesser morbidity, lesser cost, and lesser burden to the family. The initially thought disadvantages of higher chances of injuries, wound infection and stress to neonates have been countered by growing evidences. The authors agree that staged procedure will continue to stay around for few specific indications like perforation peritonitis, extreme prematurity and special anatomical entities. Further, it can have more important role with advent of laparoscopy and better health infrastructure in future. But with new developments in imaging, scopes and neonatal care, single-staged repair is a feasible and safe modality for treatment of these anomalies.     

Fluid supplementation <Emphasis Type="Italic">versus</Emphasis> no fluid supplementation in late preterm and term neonates with asymptomatic polycythemia: <Emphasis Type="Italic">A randomized controlled trial</Emphasis>

Objective

To compare supplemental intravenous fluids with no supplementation in asymptomatic polycythemic late preterm and term neonates.

Methods

55 infants with venous haematocrit of 65-75 were randomly allocated to receive either 25 mL/kg IV normal saline over 6-8 hours or routine fluids. They were followed up for 48 hours.

Results

There was no significant difference between fluid supplementation and control groups regarding need for partial exchange transfusion [6/27 (22.2%) vs 8/28 (28.6%); P=0.59].

Conclusions

We did not find any evidence of clinical benefit with IV fluid supplementation in late preterm and term neonates with asymptomatic polycythemia (PCV 65-75).

     

Clinical presentation and cardiovascular outcome in complete <Emphasis Type="Italic">versus</Emphasis> incomplete Kawasaki disease

Objective

To compare the demographic, clinical, and laboratory features of incomplete and complete presentations of Kawasaki disease.

Methods

A retrospective review of the electronic case records between January 2000 and December 2015 in a tertiary care referral center of Sohar, Oman.

Results

31 out of 64 children (48.4%) had incomplete presentation. Children with incomplete presentation had higher incidence of skin rash, lymphadenopathy and conjunctivitis. They took a longer time to show clinical response to intravenous immunoglobulin [mean (SD) 52.6 (17.4) h vs 40.1 (16.4) h, P=0.005], and had prolonged hospitalization [mean (SD) 6.2 (2.5) d vs 4.6 (1.7) d, P=0.009].

Conclusions

Children with incomplete presentation of Kawasaki disease tend to have prolonged hospitalization but short- and long-term coronary outcomes appear to be similar.

     

<Emphasis Type="Italic">NPHS2</Emphasis> mutations

Objective  To uncover the frequency and the spectrum of NPHS2 mutations in Egyptian children with non familial steroid-resistant nephrotic syndrome (SRNS). Methods  Sixteen patients were screened by PCR-single-strand conformation polymorphism analysis of NPHS2 gene followed by direct sequencing. Results   NPHS2 mutations were evident in four patients (25%) who were bearing four novel mutations including two frame shift mutations (R238fs and P45fs) and two missense mutations (I136L and F216Y). There were no phenotypic or histological characteristics of patients bearing NPHS2 mutations, apart from the earlier onset of the disease, compared to those who were not bearing mutations. Conclusion   NPHS2 mutations are prevalent in Egyptian children with non-familial SRNS and this may in part explain the less favorable prognosis reported in these patients.     

High frequency oscillatory ventilation <Emphasis Type="Italic">versus</Emphasis> synchronized intermittent mandatory ventilation in preterm neonates with hyaline membrane disease: <Emphasis Type="Italic">A randomized controlled trial</Emphasis>

This randomized controlled study was conducted to compare the efficacy and safety of High frequency oscillatory ventilation (HFOV) and Synchronized intermittent mandatory ventilation (SIMV) in preterm neonates with hyaline membrane disease requiring ventilation. The ventilation strategy in both the groups included achieving optimal lung recruitment and targeted blood gases. 49 patients received HFOV and 61 SIMV. The baseline characteristics were similar in both the groups. HFOV group demonstrated better early oxygenation, enabled reduction in oxygenation index (OI) within 24 h of ventilation (difference in mean OI at 1, 6, and 24 h of ventilation: P=0.004 in HFOV, and 0.271 in SIMV group). Duration of hospital stay was shorter in HFOV group (P=0.003). The complication rate and survival were similar in two groups.     

<Emphasis Type="Italic">Enterobius vermicularis</Emphasis> and perianal sepsis in children

Specific aetiological factors are responsible for a significant proportion of cases of perianal sepsis in children. A rarely implicated pathogen is Enterobius vermicularis, an obligate parasite with a ubiquitous presence in children. The authors describe two unequivocal instances of threadworm involvement in perianal sepsis, suggesting a pathophysiological basis.     

Aerosolized L-epinephrine <Emphasis Type="Italic">vs</Emphasis> budesonide for post-extubation stridor: <Emphasis Type="Italic">A randomized controlled trial</Emphasis>

Objective  

To compare the efficacy and adverse effects of aerosolized L-epinephrine vs budesonide in the treatment of post-extubation stridor.     

Short course <Emphasis Type="Italic">versus</Emphasis> 7-day course of intravenous antibiotics for probable neonatal septicemia: <Emphasis Type="Italic">A pilot,open-label,randomized controlled trial</Emphasis>

Objective  

To compare a short course of antibiotics (48 to 96 hours) and a standard course of antibiotics (7 days) for probable neonatal sepsis.