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Modern television sets tend to have large screens that bring their centre of gravity to the front. As a consequence of this, they are more likely to topple forwards. The US National Pediatric Trauma Registry (which is not a complete national survey) for 1988–95 contained details of 183 children under 8 years injured by falling television sets (Archives of Pediatrics and Adolescent Medicine2001;155:145–8). One hundred and five (57%) of these children were boys and 139 (76%) were aged 1–4 years. Head injuries and multiple injuries were common and 28% had moderate to critical injury. Five children died. When checking a house for child safety don't forget the television set.
Watch out for tuna burgers. In North Carolina, over a period of 8 months in 1998–99 (JAMA2001;285:1327–30) 22 people developed symptoms of histamine poisoning soon after eating tuna (as tuna burgers in 18 cases). The histamine is formed from histidine when bacteria produce histidine decarboxylase. Faulty refrigeration or repeated freezing and thawing are likely causes. Once formed, the histamine is not destroyed by cooking. There are usually about two cases of histamine fish poisoning in North Carolina per year.
Providing adequate food for people, particularly for pregnant women, in developing countries may prevent cardiovascular disease. In China, Guatemala, and Chile (International Journal of Epidemiology 2001;30:52–9) children who at birth were proportionately small (weight, length, and head circumference) had higher blood pressures at age 3–6 years. In Sweden, increase in blood pressure was related to disproportionate smallness (thinness) at birth. Proportionate smallness is a feature of chronic maternal malnutrition.
Chorioamnionitis increases the likelihood of preterm labour and of harm to the fetus and neonate. It might be thought, therefore, that giving antibiotics to the mother might be beneficial. Two large trials (ORACLE trials I and II,Lancet 2001;357: 979–98 and 989–94) have, however, shown little benefit. Neonatal outcome was not improved significantly by giving either erythromycin, or co-amoxiclav, or both, to women either in preterm labour or with preterm rupture of the fetal membranes before the onset of labour. Co-amoxiclav increased the risk of neonatal necrotising enterocolitis. A retrospective subgroup analysis of the data on women with preterm rupture of the membranes and singleton pregnancies suggested some benefit to the fetus and neonate but the significance is debatable.
In the everyday story of ordinary folk swallowing a toothbrush is not a commonplace event. But toothbrushes can be used for purposes other than that for which they were designed. A young woman in Germany (Lancet2001;357:1012) had endoscopic removal of toothbrush on two separate occasions before a diagnosis of bulimia nervosa was made. She had used the handle end of the toothbrush to induce vomiting and had accidentally swallowed it. (A clue to the diagnosis was that the toothbrush in the oesophagus onx ray was upside down (bristle end proximal).) Forty cases of toothbrush swallowing have been reported between 1988 and 2000. Almost all of the swallowers were female. Their ages ranged from 15 to 23 years and most had bulimia or anorexia nervosa.
Does vaccination against influenza prevent asthma attacks in children? A large US study (Journal of Pediatrics2001;138:306–10) has produced results which differ according to the method of analysis. Cohort analysis showed an increase in asthma attacks after vaccination but self control analysis (which included better control for asthma severity) showed a decrease in asthma attacks. An editorialist (Ibid: 301–3) questions the use of self control analysis, pointing out that it is difficult to explain a decrease, as opposed to a lack of increase, in asthma attacks after influenza vaccination. Nevertheless, she concludes that present evidence supports annual influenza immunisation of children with asthma and declares current rates of uptake (9–25% of children with asthma in the USA receive the vaccine) unacceptable.
At two hospitals in Poland (Journal of Pediatrics 2001;138:361–5) the incidence of hospital-acquired diarrhoea in children aged 1–36 months was 7% in a group randomised to take Lactobacillus GG throughout their hospital stay and 33% in a placebo group. Similar proportions (20% and 28% respectively) of the two groups acquired rotavirus in their stools but fewer in the treated group (2% v17% of the total groups) developed rotavirus diarrhoea.
A six week study at two US hospitals (Journal of the American Medical Association2001;285:214–20) included over 1000 children and over 10 000 prescriptions. There were 616 medication errors (6% of prescriptions), 115 potential adverse drug events (either mistake intercepted or mistaken prescription carried through but with no ill effect on patient), and 26 actual adverse drug effects. The rate of potential adverse drug events was greater than in previous studies of adults and greatest in the neonatal intensive care unit. Most errors occurred at the prescription stage. It was thought that almost all (93%) of the potential adverse drug events could have been prevented either by ward based clinical pharmacists or by computerised prescribing.
Exposure of the fetus to non-steroidal anti-inflammatory drugs (NSAIDs) may predispose to persistent pulmonary hypertension of the newborn (PPHN), possibly by blocking the synthesis of prostaglandins and thromboxane. In Detroit (Pediatrics2001;107:519–23) meconium samples from 40 babies with PPHN and 61 healthy control babies were analysed for NSAIDs. At least one NSAID was detected in the meconium of 35 (88%) of the PPHN group and 15 (25%) of the controls. NSAID was detected in about half of meconium samples but a little over a quarter of mothers gave a history of NSAID use.
In Israel an 18 month old child with a cardiomyopathy and clubfoot died soon after a plaster cast was removed from his foot with a plaster saw. The death, it was thought, was caused by anxiety provoked cardiac arrhythmia. A subsequent study (Journal of Bone and Joint Surgery 2001;83-B:388–90) has shown that much of the anxiety generated by these saws may be due to the noise they make. In ten children aged 5–6 years having forearm plasters removed without hearing protectors the mean increase in heart rate during the procedure was 27% whereas it was 11% in ten similar children supplied with hearing protectors.
Claims have been made on television programmes in North America that piracetam may improve the cognitive functioning of children with Down's syndrome and have apparently led to the drug being used commonly in these children. Unfortunately a randomised, double-blind, placebo-controlled, crossover study of 25 children with Down's syndrome in Toronto (Archives of Pediatrics and Adolescent Medicine 2001;155:442–8) showed no improvement in cognitive functioning with piracetam but aggressiveness, agitation, and irritability were produced in some of the children.
Children in Africa receive routine immunisations through the World Health Organisation Expanded Program on Immunisation. In rural Tanzania (Lancet2001;357:1471–7) giving a dose of sulphadoxine-pyrimethamine at each of the 2, 3, and 9 month immunisation sessions reduced clinical malaria in infancy by 59% and severe anaemia by 50%.
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