Indian Medicine

NEW YORK (Reuters Health) - A repeat course of intravenous antibiotics can improve neurologic deficits in patients with Lyme disease that has spread to the brain, new research shows. However, the improvement disappears after the treatment is stopped, leading the researchers to conclude that therapies offering more durable benefits are needed.

Lyme encephalopathy, infection of the membrane lining the brain, is usually mild to moderate in severity, but it can affect a number of cognitive functions, including memory, verbal fluency and psychomotor performance, Dr. B. A. Fallon and associates note in the medical journal Neurology.

Most patients show marked improvements in cognitive function following a 4-week course of intravenous antibiotic treatment with ceftriaxone, but some patients experience little or no improvements.

The best therapy for these patients is unclear, in large part because the underlying cause is unclear, the report indicates. The persistent cognitive deficits could be related to the effects of a past infection; Borrelia burgdorferi, another tick-borne infection; an unrecognized coinfection; or an incorrect diagnosis.

Treatment approaches to patients with this complication have ranged from observation only, to the treatment of symptoms only, to extended courses of antibiotics.

Fallon, from Columbia University in New York, and colleagues investigated the benefits of 10 weeks of intravenous ceftriaxone (trade name Rocephin) in patients with previously treated Lyme disease who continued to show memory impairments and tested positive for Lyme disease using a Western blot.

A total of 37 patients were randomly assigned to receive intravenous ceftriaxone or placebo (saline solution) for 10 weeks. The study also included 20 healthy individuals to serve as a comparison group.

In addition to having mild-to-moderate cognitive impairment, the patients suffered from fatigue, pain and impaired physical functioning, the report shows.

By week 12, numerous areas in cognitive function improved with antibiotic therapy compared with placebo. However, by evaluation at week 24, the improvements had largely disappeared.

Patients with more severe pain, fatigue, and impaired physical functioning who were treated with the antibiotic showed improvement at 12 weeks - and improvements in pain and physical functioning were still apparent after 24 weeks.

Mild, transient adverse events were noted in 6 of 23 patients (26.1 percent) given antibiotic therapy and in 1 of 14 (7.1 percent) who received placebo.

In agreement with data from three previous randomized studies, these findings clearly show "the absence of any lasting improvement in cognitive function" with prolonged antibiotic therapy, Dr. John J. Halperin, from the Atlantic Neuroscience Institute in Summit, New Jersey, writes in a related editorial.

"Given the considerable risk of serious adverse events from prolonged antibiotic treatment, it is time to look elsewhere for an effective management strategy to help patients with persistent cognitive symptoms after treatment for Lyme disease. Clearly, enough is enough."

SOURCE: Neurology, March 25, 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - Many teenage girls diagnosed with the sexually transmitted disease chlamydia become reinfected over the next year, according to a large study of students attending school health centers.

Researchers found that of 897 girls who tested positive for chlamydia at a school-based health center, about one quarter were reinfected over the following year. Middle-school students were at greatest risk, with a reinfection rate of 39 percent, the researchers report in the journal Sexually Transmitted Diseases.

It's estimated that more than 2 million Americans between the ages of 14 and 39 are infected with Chlamydia trachomatis, a bacterial STD that can be cured with antibiotics. When the infection is untreated, it can spread into the uterus and fallopian tubes, sometimes leading to chronic pelvic pain, pelvic inflammatory disease and infertility.

Because chlamydia often causes no symptoms or only mild ones, experts recommend that all sexually active women age 25 or younger be tested for the infection once a year.

Those who test positive should be tested again 3 months later to catch any repeat infection.

The current findings underscore the importance of frequently re-testing in adolescents, especially when there is a history of chlamydia, according to the researchers, led by Dr. Charlotte A. Gaydos of Johns Hopkins University in Baltimore. The results also suggest that school-based health clinics are a good place to offer these tests.

Their study included 10,600 girls, who were tested for chlamydia between 1996 and 2003 at one of 11 Baltimore school-based health centers located in 8 high schools and 3 middle schools.

Each year, between 15 percent and 20 percent of girls tested positive for the STD. And in any given year, about 25 percent of these students were reinfected when follow-up tests were within the next 12 months.

About 18,000 U.S. schools currently have health centers that provide physical and mental health services to students who want them. Most are operated by a local hospital, health department or other community health center.

The centers in the study currently treat girls who have chlamydia infection, counsel them on how to lower their STD risk, give them condoms, and notify the students' partners that they should be tested.

School health centers, the authors conclude, stand as an important weapon in controlling STD rates among adolescents.

"Schools represent a logical forum for students to access health services," the researchers write. "The installation of additional school-based health centers should be encouraged, along with school-wide screening programs for sexually active students."

SOURCE: Sexually Transmitted Diseases, March 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - A new study has some reassuring news for moms and dads who feel they're in constant conflict with their toddlers. It's the quality of that conflict, not the quantity that effects the child's healthy emotional and social development.

"It doesn't matter if you're arguing every 2 minutes with your kid or every 20 minutes," Dr. Deborah Laible of Lehigh University in Bethlehem, Pennsylvania told Reuters Health. In fact, Laible and her colleagues found the frequency of arguments between moms and toddlers in their study ranged from 4 to 55 times an hour -- but the frequency had nothing to do with the quality of their relationship.

The toddler years are a peak time for parent-child conflict, Laible and her team note. Some child development experts suggest that this conflict can help children learn important emotional lessons in addition to "social and moral norms." The frequency and quality of this conflict, they add, varies dramatically among mother-toddler pairs.

To investigate what factors might contribute to these differences, the researchers observed 64 mothers and their 30-month-old children who participated in a series of tasks in the laboratory. The women tape recorded their dinner-time interactions at home 6 months later.

The lab tasks involved typical situations that might give rise to various types of arguments; for example, the mothers were instructed to keep the child away from a shelf full of enticing toys, to ask the children to put away toys they had been playing with, and to discuss past incidents involving both negative and positive emotions.

The child-parent pairs who were the most securely attached -- meaning that the child trusted that the mother would be available and would respond sensitively, especially when the child experienced negative emotions -- were more likely to engage in constructive arguments.

Conflicts were typically resolved, with mother and child justifying their point of view, and compromises were frequently reached. Both mother and child were less likely to aggravate the argument by insisting on their point of view without explaining it, teasing, or engaging in other negative behavior.

"If they're justifying and compromising it seems to be related not only to the quality of the relationship but how well the child is adjusting in terms of social and emotional development," Laible said.

A child's temperament also played a role in conflict quality. Children who were highly active or who frequently exhibited negative emotions were less likely to justify themselves in arguments, and more likely to aggravate conflicts. The same was true of their mothers, and conflicts between these pairs were less likely to be resolved.

While a child's temperament is largely innate, Laible noted, parents can help steer their children away from less positive traits. And parents can also work toward engaging in more constructive conflict with their children by justifying their point of view, compromising, and even, in some cases giving in, she added. "You don't always have to win the argument."

SOURCE: Child Development, March/April 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - "Unintentional overdoses remain the most common cause of emergency visits for adverse drug events in children 1 to 4 years old," warns Dr. Daniel Budnitz, from the US Centers for Disease Control and Prevention.

Over a 2-year period, adverse drug events were the third leading cause of nonfatal injuries among infants and the sixth leading cause of nonfatal injuries among children aged 1 to 4 years treated in hospital emergency departments, Budnitz and colleagues report.

"A large number of children continue to go to emergency departments for medication overdoses," Budnitz said, despite education, engineering, and enforcement strategies designed to help protect children from accidental overdoses and other adverse medication reactions.

Using national surveillance data from 63 U.S. hospitals, Budnitz and colleagues estimate that 158,520 patients aged 18 years and younger visited emergency departments for adverse reactions to prescription and non-prescription medications, vaccines, vitamins, dietary supplements, and complementary and alternative therapies from 2004 to 2005.

Nearly 89 percent of the children were treated and released and the adverse reactions caused no deaths, the investigators report in The Journal of Pediatrics. However, kids from 1 to 4 years old were nearly 10 times more likely than children of other ages to be hospitalized for adverse drug events.

Moreover, children younger than 5 years were more than 4-times more likely to have an adverse drug event than children 5 years or older. Almost 45 percent of the adverse drug events were unintentional overdoses, mostly from pain relief and respiratory medications.

Checking the active ingredients of all dosed medications to insure a child is not given \two or more medicines with the same active ingredien' may help prevent unintentional overdoses, Budnitz commented.

Parents and caregivers should also use childproof packaging and storage, never leave kids alone with medicines, vitamins, or supplements, and should only medicate youngsters as directed by a physician, pharmacist, or package label. Additionally, refrain from giving cough and cold medicines to kids younger than 2 years, as well as dosing children with adult medicines, Budnitz said.

Innovative packaging and other preventive strategies may help prevent accidental overdoses among children, Buenitz and his colleagues he and colleagues note.

SOURCE: The Journal of Pediatrics, March 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - Full-term babies who are exclusively breastfed are not at heightened risk of low iron stores by the age of 6 months, even if their mothers were iron-deficient during pregnancy, a new study shows.

The findings, published online in the International Breastfeeding Journal, support experts' belief that breast milk alone provides most infants with adequate nutrition for the first 6 months of life.

Breast milk is low in iron, but infants can absorb it much more easily than they absorb the iron in fortified formula. Healthy full-term infants are also born with enough iron stores to make deficiency unlikely in the first 6 months.

In general, it's recommended that breastfed babies start on iron-fortified foods, like infant cereal, at about 6 months.

In the current study, Indian researchers followed 129 full-term babies born to 68 mothers with normal iron stores or to 61 mothers with iron- deficiency anemia. The mothers took iron and folic acid supplements as their obstetricians advised, but their infants were exclusively breastfed, without supplemental iron.

At 6 months of age, none of the babies were iron-deficient, regardless of whether their mother had been anemic, according to the researchers, led by Dr. Shashi Raj of the University College of Medical Sciences in Delhi.

It's "not surprising" that these infants had sufficient iron levels, the researchers add, given how well breast-milk iron is absorbed and the amount of iron full-term babies have at birth.

They conclude that there is no need to add iron-rich foods or iron drops to the diets of exclusively breastfed full-term infants before the age of 6 months.

The findings do not apply, however, to babies born prematurely, as their iron stores at birth are typically depleted; doctors usually recommend that breastfed preemies start on supplemental iron early on.

SOURCE: International Breastfeeding Journal, online March 1, 2008.

Copyright © 2008 Reuters Limited.