Immune Reconstitution Inflammatory Syndrome Complicating Cryptococcal Meningitis in a Pediatric Heart Transplant Patient.

Immune reconstitution inflammatory syndrome can be a complication of cryptococcal meningitis after immune reconstitution from antiretroviral therapy in HIV or reduced immune suppression in transplant recipients. In this case report, the authors discuss the diagnosis and management of cryptococcal-associated immune reconstitution inflammatory syndrome in a 10-year-old pediatric heart transplant recipient.

Case report: The use of medical yoga for adolescent mental health.

Mental health issues are epidemic among youth in the United States today. Recent studies suggest that up to 50% of all teenagers have complaints related to stress, anxiety, and/or depression. This problem is accompanied by an unprecedented rise in the rates of child and teen suicide in the United States. In response to this epidemic, the American Academy of Pediatrics is recommending universal depression screening for all teens. Medications are available to ameliorate mental health disorders, and many can be safely used in the primary care setting. However, many of these medications have unwanted side effects or may not be familiar to the primary care physician. For these reasons and others, primary care physicians require additional approaches to respond to the challenges imposed by a growing number of patients requiring mental health support. Medical Yoga Therapy, prescribed by a physician with special yoga therapy training, offers a safe and effective way to serve the patient with physical or mental challenges disabilities. Medical Yoga therapy is an individualized and personal approach to the patient, and it may be integrated with any current therapy or medical regimen. Here, evidence for medical yoga is reviewed in the context of an adolescent patient with a common disorder. Yoga practices, with particular focus on mindfulness, offer a safe and effective intervention for a growing number of pediatric patients.

Mupirocin for Staphylococcus aureus Decolonization of Infants in Neonatal Intensive Care Units.

: media-1vid110.1542/5849573989001PEDS-VA_2018-1565Video Abstract BACKGROUND AND OBJECTIVES: Staphylococcus aureus (SA) is the second leading cause of late-onset sepsis among infants in the NICU. Because colonization of nasal mucosa and/or skin frequently precedes invasive infection, decolonization strategies, such as mupirocin application, have been attempted to prevent clinical infection, but data supporting this approach in infants are limited. We conducted a phase 2 multicenter, open-label, randomized trial to assess the safety and efficacy of intranasal plus topical mupirocin in eradicating SA colonization in critically ill infants. METHODS: Between April 2014 and May 2016, infants <24 months old in the NICU at 8 study centers underwent serial screening for nasal SA. Colonized infants who met eligibility criteria were randomly assigned to receive 5 days of mupirocin versus no mupirocin to the intranasal, periumbilical, and perianal areas. Mupirocin effects on primary (day 8) and persistent (day 22) decolonization at all three body sites were assessed. RESULTS: A total of 155 infants were randomly assigned. Mupirocin was generally well tolerated, but rashes (usually mild and perianal) occurred significantly more often in treated versus untreated infants. Primary decolonization occurred in 62 of 66 (93.9%) treated infants and 3 of 64 (4.7%) control infants (P < .001). Twenty-one of 46 (45.7%) treated infants were persistently decolonized compared with 1 of 48 (2.1%) controls (P < .001). CONCLUSIONS: Application of mupirocin to multiple body sites was safe and efficacious in eradicating SA carriage among infants in the NICU; however, after 2 to 3 weeks, many infants who remained hospitalized became recolonized.

Safety and immunogenicity of seasonal trivalent inactivated influenza vaccines in pregnant women.

BACKGROUND: In the United States, seasonal inactivated influenza vaccine (IIV) is recommended for pregnant women; however, in early 2009, immunization rates were low, partly due to limited prospective data and concerns about vaccine safety. OBJECTIVE: We conducted a randomized study of two licensed seasonal trivalent IIVs (IIV3) to assess their safety and immunogenicity in pregnant women. STUDY DESIGN: In this prospective, randomized clinical study, 100 pregnant women, 18-39 years of age and ≥14 weeks gestation received a single intramuscular dose of 2008-2009 Fluzone® or Fluarix®. Injection site and systemic reactions were recorded for 7 days after vaccination and serious adverse events (SAEs) and pregnancy outcomes were documented. Serum samples collected before and 28 days after vaccination were tested for hemagglutination inhibition (HAI) antibody levels. RESULTS: The majority of the injection site and systemic reactions were mild and self-limited after both vaccines. No fever ≥100 °F was reported. There were no vaccine-associated SAEs. Immune responses to influenza vaccine antigens were similar for the two study vaccines, with robust HAI responses against influenza A strains, and relatively lower responses for influenza B strains. CONCLUSION: Seasonal inactivated influenza vaccines were well tolerated and immunogenic in pregnant women. SYNOPSIS: In this prospective clinical trial, we demonstrated that immunization with seasonal trivalent, inactivated influenza vaccine in the second and third trimester of pregnancy is immunogenic and safe.

Medical Yoga Therapy.

Medical yoga is defined as the use of yoga practices for the prevention and treatment of  medical conditions. Beyond the physical elements of yoga, which are important and effective for  strengthening  the  body,  medical  yoga  also  incorporates  appropriate  breathing  techniques,  mindfulness, and meditation in order to achieve the maximum benefits. Multiple studies have  shown that yoga can positively impact the body in many ways, including helping to regulate blood  glucose levels, improve musculoskeletal ailments and keeping the cardiovascular system in tune. It  also has been shown to have important psychological benefits, as the practice of yoga can help to  increase mental energy and positive feelings, and decrease negative feelings of aggressiveness,  depression and anxiety.

Clinical and immune responses to inactivated influenza A(H1N1)pdm09 vaccine in children.

BACKGROUND: As the influenza A H1N1 pandemic emerged in 2009, children were found to experience high morbidity and mortality and were prioritized for vaccination. This multicenter, randomized, double-blind, age-stratified trial assessed the safety and immunogenicity of inactivated influenza A(H1N1)pdm09 vaccine in healthy children aged 6 months to 17 years. METHODS: Children received 2 doses of approximately 15 or 30 µg hemagglutin antigen 21 days apart. Reactogenicity was assessed for 8 days after each dose, adverse events through day 42, and serious adverse events or new-onset chronic illnesses through day 201. Serum hemagglutination inhibition titers were measured on days 0 (prevaccination), 8, 21, 29 and 42. RESULTS: A total of 583 children received the first dose and 571 received the second dose of vaccine. Vaccinations were generally well-tolerated and no related serious adverse events were observed. The 15 µg dosage elicited a seroprotective hemagglutination inhibition (≥ 1:40) in 20%, 47% and 93% of children in the 6-35 month, 3-9 year and 10-17 year age strata 21 days after dose 1 and in 78%, 82% and 98% of children 21 days after dose 2, respectively. The 30 µg vaccine dosage induced similar responses. CONCLUSIONS: The inactivated influenza A(H1N1)pdm09 vaccine exhibited a favorable safety profile at both dosage levels. While a single 15 or 30 µg dose induced seroprotective antibody responses in most children 10-17 years of age, younger children required 2 doses, even when receiving dosages 4- to 6-fold higher than recommended. Well-tolerated vaccines are needed that induce immunity after a single dose for use in young children during influenza pandemics.

Primary treatment of incomplete Kawasaki disease with infliximab and methylprednisolone in a patient with a contraindication to intravenous immune globulin.

Incomplete Kawasaki disease was diagnosed in a 3-year-old boy. Because intravenous immune globulin infusion was not tolerated, he was treated with infliximab and methylprednisolone. Coronary aneurysms were not visualized on initial or follow-up echocardiograms. To our knowledge, this is the first report to document the use of infliximab and methylprednisolone as first line therapy for Kawasaki disease.

Prevention of enteric diseases.

Enteric diseases remain a high public health priority for much of the world's population. Improvement of sanitation and hygiene would have a favorable impact on this problem, but resources are not available to effect these interventions worldwide. Thus, vaccines against some diarrheal diseases are needed urgently. There has been much success in this arena, but much more needs to be done. Solutions will depend on new and old technologies and on continued dedication of human and financial resources to address problems of global significance.