Malnutrition and vaccination in developing countries

Malnutrition contributes to an estimated 45% of deaths among children under 5 years of age in developing countries, predominantly due to infections. Malnourished children therefore stand to benefit hugely from vaccination, but malnutrition has been described as the most common immunodeficiency globally, suggesting that they may not be able to respond effectively to vaccines. The immunology of malnutrition remains poorly characterized, but is associated with impairments in mucosal barrier integrity, and innate and adaptive immune dysfunction. Despite this, the majority of malnourished children can mount a protective immune response following vaccination, although the timing, quality and duration of responses may be impaired. This paper reviews the evidence for vaccine immunogenicity in malnourished children, discusses the importance of vaccination in prevention of malnutrition and highlights evidence gaps in our current knowledge.     

Pulled elbow: a study of 100 patients.

Pulled elbow is a common condition but may not be recognized by practitioners unaware of its existence. Most of a series of 100 children with this condition were aged 1 or 2 years, and none were over 6 years. An important precipitating factor was the normal recalcitrance of the 1-3 age group. The three children who were over 5 years had all had earlier episodes which may have stretched the annular ligament. The wrist was the most common site of pain after the elbow. A single manipulation was successful in 96 cases but multiple manipulations may be needed.     

Plasmodium falciparum gametocyte carriage, emergence, clearance and population sex ratios in anaemic and non-anaemic malarious children

Anaemia in falciparum malaria is associated with an increased risk of gametocyte carriage, but its effects on transmission have not been extensively evaluated in malarious children. Plasmodium falciparum gametocyte carriage, emergence, clearance, population sex ratios (SR) (defined as the proportion of gametocytes that are male), inbreeding rates and temporal changes in SR were evaluated in 840 malarious children. Gametocyte carriage pre-treatment was at a level of 8.1%. Anaemia at enrolment was an independent risk factor for gametocyte carriage post-treatment. The emergence of gametocytes seven days post-treatment was significantly more frequent in anaemic children (7/106 vs. 10/696, p = 0.002). In the initially detected gametocytes, the proportion of children with a male-biased SR (MBSR) (> 0.5) was significantly higher in anaemic children (6/7 vs. 3/10, p = 0.027). Pre-treatment SR and estimated inbreeding rates (proportion of a mother's daughters fertilised by her sons) were similar in anaemic and non-anaemic children. Pre-treatment SR became more female-biased in non-anaemic children following treatment. However, in anaemic children, SR became male-biased. Anaemia was shown to significantly increase gametocyte emergence and may significantly alter the SR of emerging gametocytes. If MBSR is more infective to mosquitoes at low gametocytaemia, then these findings may have significant implications for malaria control efforts in endemic settings where malaria-associated anaemia is common.     

儿童免疫性血小板减少症血清中抗核仁抗体纯化以及靶抗原的筛选

免疫性血小板减少症为儿童常见获得性免疫性疾病,本研究前期发现有较高比例的抗核仁抗体阳性的儿童为免疫性血小板减少症患者。为筛选鉴定抗核仁抗体阳性免疫性血小板减少症患儿血清中抗核仁抗体识别的靶抗原,本研究利用HEP-2细胞系建立了细胞固定-抗体结合-抗体洗脱-抗体中和体系,成功纯化免疫性血小板减少症患儿血清中抗核仁抗体。利用蛋白免疫共沉淀和质谱分析法筛选出Ncl、Krt1、Krt2、Krt10等蛋白可能为免疫性血小板减少症患儿血清中抗核仁抗体结合的靶抗原。这些结果为免疫性血小板减少症患儿血清中抗核仁抗体靶抗原的鉴定提供有效方法,可进一步深化我们对免疫性血小板减少症发病机制的认识。     

Maxillary hypoplasia secondary to midfacial trauma in childhood

Three normal children who suffered midfacial trauma and developed midfacial retrusion that would require Le Fort III advancements for correction of the deformity are described. The common denominator in these three cases seems to be an injury to the medial facial structure including the nasal septum. It is concluded that midfacial fractures in childhood may be a cause of subsequent midfacial hypoplasia.     

Cross-cultural variation in the development of folk ecological reasoning

Two studies examined children's reasoning about biological kinds in populations that vary in formal education and direct experience with the natural world, a Western (urban U.S.) and a Non-Western population (Tanna, Vanuatu). Study 1 examined children's concepts of ecological relatedness between species (N = 97, 5–13-year-olds). U.S. children provided more taxonomic explanations than Ni-Vanuatu children, who provided more ecological, physiological, and utility explanations than U.S. children. Ecological explanations were most common overall and more common among older than younger children across cultures. In Study 2, children (N = 106, 6–11-year-olds) sorted pictures of natural kinds into groups. U.S. children were more likely than Ni-Vanuatu children to categorize a human as an animal and the tendency to group a human with other animals increased with age in the U.S. Despite substantial differences in cultural, educational, and ecological input, children in both populations privileged ecological reasoning. In contrast, taxonomic reasoning was more variable between populations, which may reflect differences in experience with formal education.     

The role of multipotential stem cells in human infantile hemangioma

Hemangioma is the most common benign vascular tumor in infants and children with unknown etiology and pathogenesis. It is characterized by rapid proliferation followed by a slow involution phase. Histological analyses of infantile hemangioma (IH) in the early proliferating phase have generated a number of developmental theories suggesting an embryonic or primitive cell origin. We here hypothesize the IH may originate from multipotential stem cells. Further investigations of these hemangioma-initiating cells may improve our understanding of their function and possibly lead to novel therapeutic modalities for hemangiomas.     

Child sex rings.

Details of 11 child sex rings identified in one working class community were obtained by interviewing investigating police officers and examining health and social services records. The rings contained 14 adult male perpetrators and 175 children aged 6-15 years. Most perpetrators used child ringleaders to recruit victims; others became a "family friend" or obtained a position of authority over children. Secrecy was encouraged and bribery, threats, and peer pressure used to induce participation in sexual activities. Offences reported included fondling, masturbation, pornography, and oral, vaginal, and anal intercourse. Eleven perpetrators were successfully prosecuted; all but one received a sentence of three years or less. Behavioural problems were common among those children who had participated for a long time. Child sex rings are difficult to detect and may be common. Many children are seriously abused as a consequence of them.     

间歇性外斜视患儿的注意跟踪能力异常

间歇性外斜视是儿童眼科的常见疾病之一,也是目前眼科学研究的热点领域之一.本研究使用多物体跟踪实验范式,系统考察了间歇性外斜视儿童,相对于弱视儿童以及正常对照儿童,注意的容量是否存在异常.实验结果发现间歇性外斜视儿童和弱视儿童的注意跟踪能力都显著地差于正常对照儿童,而且间歇性外斜视儿童和弱视儿童的跟踪成绩基本没有差别,他们的注意跟踪功能的受损程度相近.本研究首次报道了间歇性外斜视儿童注意能力的行为异常,对进一步研究间歇性外斜视的发病机理和早期临床诊断具有潜在的参考意义.     

The child''s sexual life; a consideration of clinical implications

A healthy sexual life begins in childhood, and the groundwork for later difficulties also begins in childhood. For the child, sexuality is a rather general, pleasurable excitation, not a specific genital stimulation. Excessive attention to the perineal area, operation upon or injury to the genital area and injections are vicissitudes which may have an unhealthy influence on later sexual development. Healthy and informed parental attitudes are the key here, just as they are in the normal exhibitionism, curiosity and intense emotional attachments to parents. Parents infect children, healthily or unhealthily, with their attitudes. In healthy growth exhibitionism and peeping become transformed in socially acceptable ways. In unhealthy growth, either perversions or strong reactions like over-modesty or shame result. Masturbation is common and transitory in most children. Parents, and especially pediatricians to whom parents turn, have a golden opportunity to direct healthy growth by being well informed about the infant and child's sexual growth and thus be enabled to advise upon or manage the common developmental phenomena with good commonsense and patience. Infants and children do not enter the world possessing the morals, standards or inhibitions of adults.     

Effect of valerian, Valeriana edulis, on sleep difficulties in children with intellectual deficits: randomised trial.

Serious sleep problems are common in children with an intellectual deficit (ID), and are often the source of much distress for both the child and caregivers. As yet, no satisfactory long-term treatment exists for intransigent sleep difficulties in children with an ID. Valerian, Valeriana spp., has been used for thousands of years to induce relaxation and sleep. Scientific investigation of valerian's sleep promoting ability in humans, whilst limited, has yielded promising findings. This initial study aimed to explore valerian's potential for assisting in the treatment of sleep problems in children with an ID. Five children with varying intellectual deficits and different primary sleep problems underwent eight continuous weeks of monitoring via sleep diaries, adhering to a double blind, placebo controlled and randomised design. Compared to baseline and placebo, valerian treatment led to significant reductions in sleep latencies and nocturnal time awake, lengthened total sleep time and improved sleep quality. The treatment was apparently most effective in children with deficits that involved hyperactivity. Although the findings are preliminary and in need of replication, there is evidence to suggest that valerian may be useful in the safe and effective long-term treatment of intransigent sleep difficulties in children with ID's, and therefore warrants further investigation.     

Patterns of fractures in accidental and non-accidental injury in children: a comparative study.

The incidence and pattern of fractures in children who had been abused were compared with those of fractures sustained by children of similar ages in whom abuse had been excluded. From 1976 to 1982 there were 35 children with fractures resulting from child abuse, and all were aged under 5. Of the 826 children in the control group, seen from January to June 1981, 85% were aged over 5. Abused children were much more likely to have multiple fractures (p less than 0.001) and bruising of the head and neck (p less than 0.001). Fractures of the ribs were common in children who had been abused, and their presence, in the absence of major chest trauma, strongly suggested that abuse was occurring. Injuries to the long bones were invariably spiral or oblique fractures or subperiosteal new bone formation--both "gripping or twisting" injuries. Spiral fracture of the humeral shaft was significantly more common (p less than 0.001) in the group of abused children. Classic metaphyseal chip fractures were uncommon. One child in eight aged under 18 months who sustains a fracture may be a victim of child abuse.     

Down-regulation of IgE and IgG4 antibodies to tetanus toxoid and diphtheria toxoid by covaccination with cellular Bordetella pertussis vaccine

Pertussis (P) toxin acts as adjuvant for IgE formation against simultaneously administered Ags in animal models. P vaccination may also have an adjuvant impact on IgE formation against coadministered diphtheria (D) and tetanus (T) Ags in humans. Sera of 103 D-T-P-immunized and 319 D-T-immunized children aged 2 years were analyzed for IgE, IgG4, and IgG to D and T (radioallergosorbent test), total IgE and IgE against common inhalant allergens (CAP radioallergosorbent test fluoroenzyme immunoassay). Fewer D-T-P- than D-T-immunized children had sera positive for T-IgE (12.6 vs 53.6%, p < 0.001), T-IgG4 (71.6 vs 89.2%, p < 0.001), D-IgE (31.0 vs 70.5%, p < 0.001), and D-IgG4 (85.2 vs 93.4%, p = 0.039). Suppression of T-IgE was not dependent on the cutoff chosen for a positive test result, but was dependent on the proportion of D-T immunizations given with P. The risk for sensitization to common environmental allergens did not differ (odds ratio 0.953, 95% confidence interval 0.815-1.114). No significant differences between D-T- and D-T-P-immunized children were found with regard to T-IgG or D-IgG. In summary, IgE and IgG4 (but not IgG) serum levels to coadministered D- and T-Ags are suppressed among P-immunized children as compared with nonimmunized children. These results suggest that the presence of a microbial product during Ag exposure can down-regulate an IgE/IgG4 response in humans.     

Hypoglycaemia and counterregulation during childhood

Hypoglycaemia is particularly common in young children with type 1 diabetes mellitus yet the normal protective counterregulatory responses have been little studied in this age group. The studies reported have shown conflicting results, in part related to prior glycaemic control and also to the method of investigation used. Counterregulatory hormone responses during both spontaneous and experimentally induced episodes of nocturnal hypoglycaemia do appear to be blunted, which may be a function of sleep itself. Although studies of cognitive function have consistently shown defects in certain areas of neurocognitive performance, particularly in those children with early-onset diabetes or a prior history of severe hypoglycaemia, the contribution of nocturnal hypoglycaemia to the development of these impairments has not been evaluated. In young adults and adolescents, nocturnal hypoglycaemia has been linked to cardiac arrhythmia and the risk of sudden death. The development of new techniques for continuous subcutaneous glucose monitoring may allow detailed study of counterregulatory responses and symptom recognition in young children. Effective intensification of insulin therapy without an increased risk of hypoglycaemia may be possible using new insulin analogues or continued subcutaneous intravenous infusion (CSII), thus improving patient compliance and overall quality of clinical care.     

Auditory cortex responses to clicks and sensory modulation difficulties in children with autism spectrum disorders (ASD)

Auditory sensory modulation difficulties are common in autism spectrum disorders (ASD) and may stem from a faulty arousal system that compromises the ability to regulate an optimal response. To study neurophysiological correlates of the sensory modulation difficulties, we recorded magnetic field responses to clicks in 14 ASD and 15 typically developing (TD) children. We further analyzed the P100m, which is the most prominent component of the auditory magnetic field response in children and may reflect preattentive arousal processes. The P100m was rightward lateralized in the TD, but not in the ASD children, who showed a tendency toward P100m reduction in the right hemisphere (RH). The atypical P100m lateralization in the ASD subjects was associated with greater severity of sensory abnormalities assessed by Short Sensory Profile, as well as with auditory hypersensitivity during the first two years of life. The absence of right-hemispheric predominance of the P100m and a tendency for its right-hemispheric reduction in the ASD children suggests disturbance of the RH ascending reticular brainstem pathways and/or their thalamic and cortical projections, which in turn may contribute to abnormal arousal and attention. The correlation of sensory abnormalities with atypical, more leftward, P100m lateralization suggests that reduced preattentive processing in the right hemisphere and/or its shift to the left hemisphere may contribute to abnormal sensory behavior in ASD.     

Children in an ageing society

This paper explores the implications of demographic aging for children and pediatric practice in the Western society. It focuses on the social class differences in childbearing patterns, specific issues related to disability, and distribution of resources between age groups. Women in the Western world are now having children at an older age than at any time in the past 50 years. Voluntary childlessness or deliberate delay in childbearing is common among highly educated women. This changing pattern in childbearing may increase and polarize health and wealth inequalities. With advancements in neonatal and pediatric care which prolong life expectancy and survival of disabled children, it is projected that there will be an increasing number of very old parents caring for severely disabled offspring. Meanwhile, there are also many children who are carrying considerable burdens of caring for their disabled parents. The community burden of disability will continue to rise. The needs of the elderly population may drain resources from child health services. Despite this demographic pattern, care for the children is still important. Health care authorities must not become contented with the existing pediatric care services just because demographic changes require that the nation should invest more in care of the older population.     

Decreased HLA heterogeneity in parents of children with Down syndrome.

HLA-A and B antigens were determined in a study of 37 couples and their children with trisomy 21 Down syndrome (DS), using a standard microlymphocytotoxicity test. The comparison groups included 76 couples and their healthy children. All individuals were Caucasians from the same geographical area, and there was no history of consanguinity. The parents of children with DS did not show an association with a specific HLA antigen or haplotype. Sixteen of the 37 couples (43.24%) having children with DS share two or more antigens at the A and/or B locus. This was significantly higher than the proportion in the control group (6/76, or 7.88%). Of the 16 couples having children with DS and sharing two or more antigens, eight had a haplotype in common, in contrast with only two couples in the control group. The data suggest that sharing of parental HLA-A and B antigens may be related either to the occurrence of trisomy 21 zygotes or to prenatal survival of affected embryos and fetuses.     

Characterisation of regulatory T cells in nasal associated lymphoid tissue in children: relationships with pneumococcal colonization

Regulatory T cells (Treg) diminish immune responses to microbial infection, which may contribute to preventing inflammation-related local tissue damage and autoimmunity but may also contribute to chronicity of infection. Nasopharyngeal carriage of pneumococcus is common in young children and can persist for long periods but it is unknown whether the presence of Treg in the nasopharynx contributes to this persistence. We have investigated the numbers and activities of Foxp3+Treg in adenoidal tissues and their association with pneumococcal carriage in children. Expression of Treg cell-related markers including Foxp3, CD25, CD39, CD127 and CLTA4 were analysed by flow-cytometry in adenoidal mononuclear cells (MNC) and PBMC from children. Unfractionated MNC or Treg-depleted MNC were stimulated with a pneumococcal whole cell antigen (WCA) and T cell proliferation measured. Cytokine production by MNC was measured using a cytometric bead array. Higher numbers of CD25(high)Foxp3(high) Treg expressing higher CD39 and CTLA4 were found in adenoidal MNC than in PBMC. Children with pneumococcus positive nasopharyngeal cultures had higher proportions of Treg and expressed higher levels of CD39 and CTLA-4 than those who were culture negative (-). WCA induced adenoidal Treg proliferation which produce IL10 but not IL17, and CD4 T cell proliferation in Treg-depleted MNC was greater in pneumococcal culture positive than negative children. Significant numbers of Treg with an effector/memory phenotype which possess a potent inhibitory effect, exist in adenoidal tissue. The association of pneumococcal carriage with an increased frequency of adenoidal Treg suggests that Treg in nasal-associated lymphoid tissue (NALT) may contribute to the persistence of pneumococcus in children. Further studies to determine what component and mechanisms are involved in the promotion of Treg in NALT may lead to novel therapeutic or vaccination strategy against upper respiratory infection.     

Enterotoxigenic Escherichia coli in children with acute diarrhoea and controls in Teresina/PI, Brazil: distribution of enterotoxin and colonization factor genes

Aims: To investigate the distribution of the genes that encode enterotoxins and the colonization factors (CF) types as well as the antibiotic susceptibility profile of enterotoxigenic Escherichia coli (ETEC) isolated from children from the Brazilian Northeast. Methods and Results: We conducted a 3·5‐year prospective study that involved 250 children with and 150 without diarrhoea, aged 1–60 months, from low‐income families in Teresina/Brazilian Northeast. All samples were assayed for E. coli, enterotoxin and CF genes and antimicrobial susceptibility by microbiological methods and PCR. ETEC strains were isolated from 9·2% children with and 4·0% without diarrhoea. Infection was more common in children aged 6–24 months in rainy months. elt⁺/CFA/IV⁺ and elt⁺/CS14⁺ were the most frequent genotypes. Susceptibility to nalidixic acid, ciprofloxacin and gentamicin and resistance to ampicillin, cephalothin and sulfamethoxazole–trimethoprim were common. Conclusions: elt ⁺ isolates and ETEC strains harbouring genes encoding CFA/IV and CS/14 were the most common ETEC found in Brazilian Northeast. Significance and Impact of the Study: Our data, the first generated for north‐eastern Brazilian children, may be important for the development of an effective vaccine and for facilitation of an empirical choice of antibiotic treatment or prophylaxis for traveller’s diarrhoea in the area studied.     

THE CHILD'S SEXUAL LIFE—A Consideration of Clinical Implications

A healthy sexual life begins in childhood, and the groundwork for later difficulties also begins in childhood. For the child, sexuality is a rather general, pleasurable excitation, not a specific genital stimulation. Excessive attention to the perineal area, operation upon or injury to the genital area and injections are vicissitudes which may have an unhealthy influence on later sexual development. Healthy and informed parental attitudes are the key here, just as they are in the normal exhibitionism, curiosity and intense emotional attachments to parents. Parents infect children, healthily or unhealthily, with their attitudes. In healthy growth exhibitionism and peeping become transformed in socially acceptable ways. In unhealthy growth, either perversions or strong reactions like over-modesty or shame result. Masturbation is common and transitory in most children. Parents, and especially pediatricians to whom parents turn, have a golden opportunity to direct healthy growth by being well informed about the infant and child''s sexual growth and thus be enabled to advise upon or manage the common developmental phenomena with good commonsense and patience. Infants and children do not enter the world possessing the morals, standards or inhibitions of adults.