Practical management of suspected hypersensitivity reactions to anti-tuberculosis drugs.

Tuberculosis (TB) is the commonest cause of death by a single infectious agent globally and ranks amongst the top ten causes of global mortality. The incidence of TB is highest in Low-Middle Income countries (LMICs). Prompt institution of, and compliance with, therapy are cornerstones for a favourable outcome in TB and to mitigate the risk of multiple drug resistant (MDR)-TB, which is challenging to treat. There is some evidence that adverse drug reactions (ADRs) and hypersensitivity reactions (HSRs) to anti-TB drugs occur in over 60% and 3%-4% of patients respectively. Both ADRs and HSRs represent significant barriers to treatment adherence and are recognised risk factors for MDR-TB. HSRs to anti-TB drugs are usually cutaneous and benign, occur within few weeks after commencement of therapy and are likely to be T-cell mediated. Severe and systemic T-cell mediated HSRs and IgE mediated anaphylaxis to anti-TB drugs are relatively rare, but important to recognise and treat promptly. T-cell-mediated HSRs are more frequent amongst patients with co-existing HIV infection. Some patients develop multiple sensitisation to anti-TB drugs. Whilst skin tests, patch tests and in vitro diagnostics have been used in the investigation of HSRs to anti-TB drugs, their predictive value is not established, they are onerous, require specialist input of an allergist and are resource-dependent. This is compounded by the global, unmet demand for allergy specialists, particularly in low-income countries (LICs)/LMICs and now the challenging circumstances of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. This narrative review provides a critical analysis of the limited published evidence on this topic and proposes a cautious and pragmatic approach to optimise and standardise the management of HSRs to anti-TB drugs. This includes clinical risk stratification and a dual strategy involving sequential re-challenge and rapid drug desensitisation. Furthermore, a concerted international effort is needed to generate real-time data on ADRs, HSRs, safety and clinical outcomes of these interventions.

Early Childhood Caries and Nutritional Status of Children: A Review.

BACKGROUND: Early childhood caries (ECC) is a serious public health issue affecting children around the world. Severe symptoms and complications commonly found with ECC are adverse effects on health and growth retardation triggered by sensitivity, pain, and abscesses associated with decayed teeth, premature tooth loss, and insufficient food intake due to difficulty in chewing and keeping food in the mouth. OBJECTIVE: This article aims to provide an overview of the most recent and current evidence on the association between ECC and nutritional status with an aim to stimulate further research and to identify the impact of nutritional status on ECC and vice versa. METHODS: PubMed, Web of Science, and Google Scholar databases were used to search the studies conducted between 2016 and 2022. The included studies were searched using some keyword combinations and saved in Mendeley Desktop for review and referencing. All books, policy briefs, thesis/dissertations, and non-peer-reviewed articles were excluded, and 47 studies were selected for this narrative review. RESULTS: Many studies have identified long-term, frequent, and nocturnal bottle-feeding and breastfeeding as well as frequent consumption of sugary food and beverages as high-risk factors for ECC. Adverse nutritional status assessed by anthropometric measures, vitamin D status, and iron-deficiency anemia have been studied as risk factors for ECC. CONCLUSIONS: Most of the prevailing studies are either case-control or cross-sectional studies, which are unable to provide strong evidence to prove the direction of causality. Thus, further prospective studies are needed to clarify the association between ECC and the nutritional status of children.

Community acquired paediatric pneumonia; experience from a pneumococcal vaccine- naive population.

BACKGROUND: Childhood pneumonia continues to be a disease that causes severe morbidity and mortality among children mainly in South-East Asia and Africa though it is not so in the developed world. Pneumonia accounts for 16% of all deaths of children under 5 years old in the world, killing nearly one million children in 2015. In Sri Lanka, there were 21,000 reported cases of pneumonia in 2006, 40% were in the age group of less than 4 years. METHODS: This was a retrospective study done on the children aged 1 month to 14 years who were admitted to the Professorial Paediatric unit of Teaching Hospital, Peradeniya between 1st of March 2016 and 30th of July 2017 fulfilling diagnostic criteria for community-acquired pneumonia. Data including diagnosis, clinical details, management details and other relevant data were collected from patient records by using a data collection sheet. RESULTS: In this study, 48% of 127 patients admitted with community-acquired pneumonia had bronchopneumonia. About 2/3 of the patients neededa secondline of intravenous antibiotics while 51/ 127 needed care in the high dependency unit with supplemental oxygen. No mortality was observed in the group. CONCLUSIONS: Community- acquired paediatric pneumonia has a significant associated morbidity but not mortality in the studied population. The need for the second-line treatment with intravenous antibiotics in a significant proportion of patients may indicate a high degree of antibiotic resistance. Introduction of national antibiotic policy will help the cause.

Environmental exposure to agrochemicals and allergic diseases in preschool children in high grown tea plantations of Sri Lanka.

BACKGROUND: Exposure to agrochemicals is one of the many aetiological agents, postulated to cause allergic diseases. In this study, we have compared the prevalence of allergic diseases among preschool children growing in environments exposed to agrochemicals and artificial fertilizers with those who are not exposed to them. METHODS: Our study was conducted on preschool children in two tea estates in the hill country of Sri Lanka, one using conventional agricultural practices and the other using organic practices. Data collection was done by using an interviewer administered questionnaire. Children with potential allergic conditions were further evaluated clinically by medical officers. Blood was drawn for full blood count and a blood picture. RESULTS: Data from 81 preschool children from an organic estate (Haputale) and 101 preschool children from a conventional estate (Thalawakelle) were analysed. Wheezing was noted in 41.2% of children from the organic estate and 59.8% from the conventional estate. The respective percentages for allergic rhinitis were as 37.7% and 82.5% while for eczema they were 17.5% and 20.28%. Among the two populations percentages of eosinophilia > 600/mm3 were as 26.1% and 34.1% respectively. CONCLUSIONS: Allergic conditions were more common in preschool children with environmental exposure to agrochemicals and chemical fertilizers when compared to that of organic cultivation systems. Stricter rules are needed when using agrochemicals to prevent their harmful effects, including allergic diseases, on children.