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!!

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.

Viewpoint

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.

Source

Abstract

 

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.

Viewpoint

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.

Source

Abstract

 

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