Vitamin C and asthma in children: modification of the effect by age, exposure to dampness and the severity of asthma

Retraction: Clinical and Translational Allergy 2012, 2:6BACKGROUND: We previously found a significant benefit of vitamin C supplementation in asthmatic children. PURPOSE: To test whether the effect of vitamin C on asthma is heterogeneous over the participant population. METHODS: Egyptian asthmatic children between 7 and 10 years of age (n = 60) were included in the cross-over trial. They were administered 0.2 grams per day of vitamin C and placebo for separate 6-week periods. The variation in the vitamin C effect on two clinically relevant outcomes was analyzed: the childhood asthma control test (C-ACT), which measures the severity of asthma symptoms (the scale ranges from 0 to 27 points, < 20 points indicating unsatisfactory asthma control), and FEV1. We used linear modeling to examine the variation of the vitamin C effect in the subgroups. RESULTS: The effect of vitamin C on the C-ACT was significantly modified by age and baseline C-ACT levels. In the children aged 7.0-8.2 years with a baseline C-ACT of 18 to 19 points, vitamin C increased the C-ACT score by 4.2 points (95% CI: 3.3-5.3); whereas in the children aged 8.3-10 years who had a baseline C-ACT of 14 to 15 points, vitamin C increased the C-ACT score by only 1.3 points (95% CI: 0.1-2.5). The effect of vitamin C on the FEV1 levels was significantly modified by age and exposure to dampness. In the children aged 7.0-8.2 years with no exposure to dampness, vitamin C increased the FEV1 level by 37% (95% CI: 34-40%), whereas in the children aged 8.3-10 years with exposure to dampness or mold in their bedroom more than one year prior to the study, vitamin C increased the FEV1 level by only 21% (95% CI: 18-25%). CONCLUSIONS: We found strong evidence that the effect of vitamin C on asthmatic children is heterogeneous. Further research is needed to confirm our findings and identify the groups of children who would receive the greatest benefit from vitamin C supplementation.Peer reviewe

Community-acquired Pneumonia in Hospitalized Urban Young Nigerian Children:Clinical and Haematological Correlates of Diagnosis and Outcome.

As part of a comprehensive hospital-based study of acute lower respiratory infections (ALRI) in under-five urban Nigerian children, we sought to identify the possible clinical and investigative correlates of lobar versus bronchopneumonia, and the possible determinants of mortality in community-acquired pneumonia. Over a 30-month period, 419 cases of ALRI were studied; pneumonia accounted for 323(77.1 per cent) of these. Of those with pneumonia, bronchopneumonia (BP) was diagnosed in 234 (72.4 per cent), lobar pneumonia (LP) in 66 (20.4 per cent), while 23(7.1 per cent) had features of both. BP alone (BPA) and LP alone (LPA) without concomitant respiratory syndromes were diagnosed in 127(39.4 per cent) and 39 (12.1 per cent) cases , respectively. Although there was an overall annual preponderance of BP admissions, the peak admissions for LP was recorded in the harmattan months of November through January. The overall mean age was 15.7 months, but compared with those with LPA, BPA cases were significantly younger (mean ages, 14.2 13.8mo. for BPA vs. 19.514.2mo. for LPA, p=0.021), had a significantly shorter mean duration of cough (p=0.044), and a higher prevalence of convulsion (p=0.02). Furthermore, concomitant measles, heart failure, and severe anaemia were significantly commoner among cases with a diagnosis of BP (p=0.018, 0.033, & 0.009 respectively). On the other hand, LPA cases were associated with a significantly higher prevalence of cigarette smoking in the household (p=0.038; RR=1.86; 95%CI=0.93-5.80), grunting respiration (p=0.01), and a higher mean admission temperature (p=0.03). Also, pleural effusion and sickle cell disease correlated more frequently with a final diagnosis of LP (p=0.00 & 0.01 respectively). Similarly, compared with BPA cases, significantly higher white blood cell (WBC) counts and polymorphs were recorded in LPA cases (p=0.002 & 0.01). A fatal outcome was recorded in 35(10.8 per cent) cases. Mortality was significantly higher in those with pre-admission antimicrobial use (p=0.04), a combination of diarrhoea and vomiting (p=0.025), domestic firewood burning (p=0.023), and malnutrition (p=0.0003). A fatal outcome was also significantly associated with longer symptom duration for cough (p=0.002), fever (p=0.002), poor feeding (p=0.016), higher mean WBC counts and polymorphs (p=0.013 & 0.023 respectively). Harmattan season, grunting respiration, longer symptom-duration, and pleural effusion correlated most frequently with a final diagnosis of LP, while a younger age, anaemia, heart failure and measles were more frequently associated with BP. The association of fatality with malnutrition, pre-admission antibiotic use, concomitant alimentary symptoms, longer symptom-duration, and high WBC/polymorph counts suggests the need for factoring these parameters into evolving a regional paediatric pneumonia severity index and therapeutic decision algorithms.Nigerian Journal of Paediatrics 2001:28:101 pp. 101-11

Socioeconomic constraints to effective management of Burkitt's lymphoma in south-eastern Nigeria

This paper presents health outcomes and associated socioeconomic factors of 41 children admitted to a tertiary care institution in south-east Nigeria with Burkitt's lymphoma (BL) between 1987 and 2004. BL responds well to chemotherapy and does not pose a significant threat to health in industrialized nations. However, in resource-poor settings where it is endemic, socioeconomic factors significantly affect access to care for affected children, making this readily treatable condition a cause of considerable distress and early death in affected children. Half of the children reported in this paper presented with late stage disease. Although laboratory facilities were available, they were not accessible to all the children. Nearly a quarter of parents of these children could not afford the cost of confirmatory tests, and about a fifth (n = 8; 19.5%) of the children received no chemotherapy because of their parents' inability to pay. Only 21 of 41 children (51.2%) remained on treatment long enough (at least 12 weeks) to enable them to be confirmed either as short-term cure (n = 9; 64.3%), or as early relapse (n = 2; 4.9%). Owing to financial constraint, 13 of the parents (31.7%) withdrew their children against medical advice (n = 7; 17.1%) or left the hospital (n = 6; 14.6%). To address the challenge posed by these factors, we call for the establishment of a regional BL programme in Africa to help establish a critical mass of resources (human and material) to facilitate the development of an effective and accessible control programme in the region