The socioeconomic impact of tuberculosis on children and adolescents: a scoping review and conceptual framework.

BACKGROUND: Tuberculosis (TB) has been repeatedly shown to have socioeconomic impacts in both individual-level and ecological studies; however, much less is known about this effect among children and adolescents and the extent to which being affected by TB during childhood and adolescence can have life-course implications. This paper describes the results of the development of a conceptual framework and scoping review to review the evidence on the short- and long-term socioeconomic impact of tuberculosis on children and adolescents. OBJECTIVES: To increase knowledge of the socioeconomic impact of TB on children and adolescents. METHODS: We developed a conceptual framework of the socioeconomic impact of TB on children and adolescents, and used scoping review methods to search for evidence supporting or disproving it. We searched four academic databases from 1 January 1990 to 6 April 2021 and conducted targeted searches of grey literature. We extracted data using a standard form and analysed data thematically. RESULTS: Thirty-six studies (29 qualitative, five quantitative and two mixed methods studies) were included in the review. Overall, the evidence supported the conceptual framework, suggesting a severe socioeconomic impact of TB on children and adolescents through all the postulated pathways. Effects ranged from impoverishment, stigma, and family separation, to effects on nutrition and missed education opportunities. TB did not seem to exert a different socioeconomic impact when directly or indirectly affecting children/adolescents, suggesting that TB can affect this group even when they are not affected by the disease. No study provided sufficient follow-up to observe the long-term socioeconomic effect of TB in this age group. CONCLUSION: The evidence gathered in this review reinforces our understanding of the impact of TB on children and adolescents and highlights the importance of considering effects during the entire life course. Both ad-hoc and sustainable social protection measures and strategies are essential to mitigate the socioeconomic consequences of TB among children and adolescents.

Integration of TB into child health policies in Africa's high-burden countries: a normative analysis.

Integration of paediatric TB care into decentralised child health services has the potential to reduce the large proportion of childhood TB that remains undiagnosed. We performed a review of national guidelines and policies for TB and child health to evaluate the normative integration of paediatric TB into existing child health programmes in 15 high TB burden countries in Africa. While integration is addressed in 80% of the national strategic plans for TB, the child health strategies insufficiently address TB in their plans to reduce child mortality. Emphasis needs to be put on multi-sectoral collaboration among national health programmes.

Intégrer la prise en charge antituberculeuse de l'enfant aux services de soins pédiatriques décentralisés pourrait permettre de réduire la proportion élevée de cas de TB pédiatriques qui restent non diagnostiqués. Nous avons examiné les politiques et recommandations nationales en matière de TB et de soins pédiatriques afin d'évaluer l'intégration normative de la TB pédiatrique aux programmes de prise en charge pédiatrique existant dans 15 pays africains à forte prévalence de TB. Cette intégration est abordée dans 80% des plans stratégiques nationaux pour la TB, mais les stratégies relatives aux soins pédiatriques ne tiennent pas suffisamment compte de la TB dans leurs plans visant à réduire la mortalité infantile. Il convient de mettre l'accent sur la collaboration multisectorielle entre les programmes de santé nationaux.

Cerebellar Grey Matter Volume in Older Persons Is Associated with Worse Cognitive Functioning.

The cerebellum is increasingly recognised for its role in modulation of cognition, behaviour, and affect. The present study examined the relation between structural cerebellar damage (grey matter volume (GMV), white matter hyperintensities (WMHs), lacunar infarcts (LIs) and microbleeds (MBs)) and measures of cognitive, psychological (i.e. symptoms of depression and apathy) and general daily functioning in a population of community-dwelling older persons with mild cognitive deficits, but without dementia. In 194 participants of the Discontinuation of Antihypertensive Treatment in Elderly People (DANTE) Study Leiden, the association between cerebellar GMV, WMHs, LIs and MBs and measures of cognitive, psychological and general daily functioning was analysed with linear regression analysis, adjusted for age, sex, education and cerebral volume. Cerebellar GMV was associated with the overall cognition score (standardised beta 0.20 [95% CI, 0.06-0.33]). Specifically, posterior cerebellar GMV was associated with executive function (standardised beta 0.18 [95% CI, 0.03-0.16]). No relation was found between vascular pathology and cognition. Also, no consistent associations were found on the cerebellar GMV and vascular pathology measures and psychological and general daily functioning. In this population of community-dwelling elderly, less posterior cerebellar GMV but not vascular pathology was associated with worse cognitive function, specifically with poorer executive function. No relation was found between cerebellar pathology and psychological and general daily functioning.

Cognitive impairment in multiple sclerosis.

Cognitive impairment occurs in 40-65% of multiple sclerosis (MS) patients, typically involving complex attention, information processing speed, (episodic) memory and executive functions. It is seen in the subclinical radiologically isolated syndrome, clinically isolated syndrome, and all phases of clinical MS. In pediatric-onset MS cognition is frequently impaired and worsens relatively rapidly. Cognitive impairment often affects personal life and vocational status. Depression, anxiety and fatigue aggravate symptoms, whereas cognitive reserve partially protects. Cognitive dysfunction correlates to brain magnetic resonance imaging (MRI) lesion volumes and (regional) atrophy, and degree of and increase in MRI abnormalities predict further worsening. Experimental MRI indicates a crucial role for (focal) cortical lesions and atrophy, abnormal cortical integrity, and early changes in normal appearing brain tissue. Functional MRI suggests compensatory reorganization and adaptation changes in neural activities. Screening tools are the Brief Repeatable Neuropsychological Battery, Symbol Digit Modalities Test and Audio Recorded Cognitive Screen. The Minimal Assessment of Cognitive Function in Multiple Sclerosis (MS) is used for formal neuropsychological evaluation. What constitutes a clinically relevant change and how to optimally monitor cognition are issues to be settled. In relapsing-remitting MS timely and adequate disease modifying drug treatment may stabilize or possibly improve cognition. There is no evidence-based symptomatic drug treatment, nor are there optimal non-pharmacological approaches. Leisure activities enhance cognitive reserve. Cognitive rehabilitation in MS patients is still in its infancy. Cognitive behavioral therapy, exercise, and education programs are promising psychosocial interventions to improve coping and lessen cognitive symptoms.

Guidelines for the transfusion of red cells.

The following recommendations, which aim at standardising and rationalising clinical indications for the transfusion of red cells in Belgium, were drawn up by a working group of the Superior Health Council. To this end, the Superior Health Council organised an expert meeting devoted to "Guidelines for the transfusion of red cells" in collaboration with the Belgian Hematological Society. The experts discussed the indications for red cell transfusions, the ideal red cell concentrate, the practical issues of administering red cells, and red cell transfusions in patients in a critical condition. The recommendations formulated by the experts were validated by the working group with the purpose of harmonising red cell transfusion in Belgian hospitals.

[Anxiety disorders and epilepsy: not unknown, but sometimes unexpected. A case study]. / Angstklachten en epilepsie: niet onbekend, maar soms onverwacht.

Epileptic disorders can manifest themselves with symptoms of anxiety and panic. In clinical practice it is not always easy to achieve a correct diagnosis. The subject of this case study is an adult with symptoms of anxiety and panic who was referred to the mental health care service but who was diagnosed as having epilepsy when subjected to a supplementary examination. Psychological and in particular anxiety symptoms in epilepsy are discussed. The psychiatrist needs to consider the possibility of epilepsy in a patient presenting with anxiety symptoms.

[The Location Learning Test as a measure of spatial memory: applicability of a modified administration procedure and normative data]. / De Location Learning Test als maat voor het ruimtelijk geheugen: bruikbaarheid van een nieuwe afnameprocedure en normgegevens.

The Location Learning Test is a neuropsychological test that can be used to assess memory for object locations. The test has originally been developed for the assessment of visuo-spatial memory impairment in patients with dementia. However, ceiling effects may be present in other patient groups. This study has examined the applicability of a modified administration procedure with a shorter presentation duration and longer delay. The test was administered in a group of stroke patients (n = 105), a group of patients with diabetes (n = 93), as well as a group of healthy volunteers (n = 97). The results indicate that the Location Learning Test can be used to discriminate the diabetes and stroke patients from the control group. Furthermore, differences between patients with a left and a right-hemisphere stroke were found. The test has a high correlation with another memory test. The performance of the group healthy volunteers was used to calculate normative data for use in clinical practice.

[Diabetic encephalopathy: an underexposed complication of diabetes mellitus]. / Diabetische encefalopathie: een onderbelichte complicatie van diabetes mellitus.

Diabetes mellitus seems to be associated with gradually developing end-organ damage to the central nervous system. This relatively unknown complication of both diabetes type 1 and type 2 can be referred to as 'diabetic encephalopathy'. Measurable manifestations are electrophysiological and structural changes and limitations in the cognitive functioning. The mechanisms responsible for this diabetic encephalopathy are only partially known. Chronic metabolic and vascular changes seem to play an important role. The effects of diabetes on the brain are most distinct in the elderly. This may be the consequence of interactions between the mechanisms that underlie the ageing of the brain, dementia and the origin of diabetic complications. At present there are few leads for the targeted diagnostics and treatment of individual patients.

The stress- and abscisic acid-induced barley gene HVA22: developmental regulation and homologues in diverse organisms.

Abscisic acid (ABA) induces the expression of a battery of genes in mediating plant responses to environmental stresses. Here we report one of the early ABA-inducible genes in barley (Hordeum vulgare L.), HVA22, which shares little homology with other ABA-responsive genes such as LEA (late embryogenesis-abundant) and RAB (responsive to ABA) genes. In grains, the expression of HVA22 gene appears to be correlated with the dormancy status. The level of HVA22 mRNA increases during grain development, and declines to an undetectable level within 12 h after imbibition of non-dormant grains. In contrast, the HVA22 mRNA level remains high in dormant grains even after five days of imbibition. Treatment of dormant grains with gibberellin (GA) effectively breaks dormancy with a concomitant decline of the level of HVA22 mRNA. The expression of HVA22 appears to be tissue-specific with the level of its mRNA readily detectable in aleurone layers and embryos, yet undetectable in the starchy endosperm. The expression of HVA22 in vegetative tissues can be induced by ABA and environmental stresses, such as cold and drought. Apparent homologues of this barley gene are found in phylogenetically divergent eukaryotic organisms, including cereals, Arabidopsis, Caenorhabditis elegans, man, mouse and yeast, but not in any prokaryotes. Interestingly, similar to barley HVA22, the yeast homologue is also stress-inducible. These observations suggest that the HVA22 and its homologues encode a highly conserved stress-inducible protein which may play an important role in protecting cells from damage under stress conditions in many eukaryotic organisms.

In situ hybridization studies of UDP-glucuronosyltransferase UGT1A6 expression in rat testis and brain.

UDP-glucuronosyltransferases (UGTs), in addition to their role in overall pharmacokinetics, play important roles in local protection of cells against toxins and in the control of endogenous receptor ligands. UGT1A6, which conjugates planar phenols, appears to be expressed in many organs, but information on cell-specific expression in these organs is controversial or absent. Therefore, a non-isotopic in situ hybridization method was developed and applied to localize UGT1A6 expression in rat testis and brain. It was found that UGT1A6 is expressed in Sertoli cells and spermatogonia of rat testis and in brain neurons, in particular in hippocampal pyramidal cells and Purkinje cells of the cerebellum.

Angiomyolipoma of the kidney and lymph nodes.

Angiomyolipoma (AML) is a benign mesenchymal tumor predominantly occurring in the kidney. Despite its low incidence of 0.07-0.03% in an unselected population, this tumor is well known, because the typical AML can be diagnosed without histological confirmation by a combination of ultrasound (US) and computerized tomography (CT) imaging in up to 95% of cases. In contrast, simultaneous involvement of the kidney and the regional lymph nodes is less known and might be confused with metastasizing malignant tumor. We report a case of the very uncommon simultaneous involvement of the kidney and the lymph nodes in AML.

Motor nerve refractory period distribution assessed by two techniques in diabetic polyneuropathy.

The techniques introduced by Kimura and Ingram et al. were applied to assess the distribution of motor refractory periods (DMRPs) in peroneal nerve fibres of 28 diabetics with symptoms indicating polyneuropathy and in 28 controls. Results were compared with conventional motor nerve conduction velocity (MNCV) and compound muscle action potential (CMAP) measurements. MRP95 and MRP90 (the 5% and 10% slowest recovering fibres) obtained with Ingram's technique were prolonged in the diabetic patients. In the 26 patients with a value of MRP95 and MNCV, a prolonged MRP95 and a decreased MNCV were found in 12 patients. Thus conventional MNCV had a sensitivity of 46% to detect neuropathy; addition of MRP95 obtained with Ingram's technique raised the sensitivity to 73%. Specificity was 100% in both cases. With Kimura's technique or with the fast recovering fibres in Ingram's technique, it was not possible to discriminate the patients from the controls. This study indicates that measurement of the DMRP with the technique introduced by Ingram et al. improves the electrophysiological diagnosis of diabetic polyneuropathy.

Determination of p-toluenesulfonamide in ice cream by combination of continuous flow and liquid chromatography: summary of collaborative study.

A collaborative study of the determination of p-toluenesulfonamide (p-TSA) in ice cream by a combination of continuous flow and on-line liquid chromatography was conducted. Seven ice cream samples containing 0-6.35 mg p-TSA/kg at 4 levels (1 blank and 3 pairs of split level samples) were analyzed by 11 laboratories. For all samples analyzed, the repeatability relative standard deviation varied from 2.08 to 3.67%, whereas the reproducibility relative standard deviation ranged from 7.79 to 11.68%. The average p-TSA values for the split levels 1, 2, and 3 were 0.55, 1.02, and 4.44 mg p-TSA/kg, respectively, with mean recoveries ranging from 76 to 79% (overall recovery range for all levels, 63-101%). No false positive results were reported for the blank sample, and no interference was encountered by the presence of vanillin in samples. The method has been adopted first action by AOAC INTERNATIONAL. 993.22 p-Toluenesulfonamide Residues in Ice Cream-Combined Continuous Flow and Liquid Chromatographic Method.

Continuous flow and liquid chromatographic determination of p-toluenesulfonamide in ice cream: interlaboratory study.

A collaborative study of the continuous flow (CF) and liquid chromatographic determination of p-toluene-sulfonamide (p-TSA) in ice cream was conducted by the Project Group on Collaborative Studies (PCS) of the Inspectorate for Health Protection, Food Inspection Service, The Netherlands. The procedure involves extraction of samples with water followed by cleanup of the extracts by dialysis in the CF system. Dialysates are injected by using a loop injector (500 microL) on a reversed-phase octadecylsilane bonded-phase (C18) column, chromatographed with methanol-water (25 + 75, v/v) as mobile phase, and quantitated by fluorescence detection at 230 nm (excitation) and 295 nm (emission). Seven ice-cream samples containing 0-6.35 mg/kg p-TSA at 4 different levels (1 blank and 3 pairs of split-level samples) were singularly analyzed according to the proposed procedure by 11 laboratories. The data were analyzed by the International Union of Pure and Applied Chemistry/International Organization for Standardization/AOAC protocol for statistics. No Cochran and Grubbs outliers were found among the participants. For all samples analyzed, repeatability relative standard deviations (RSDr) varied from 2.08 to 3.67%, whereas the reproducibility relative standard deviations (RSDR) ranged from 7.79 to 11.68%. The average p-TSA values for the split levels 1, 2, and 3 were 0.55, 1.02, and 4.44 mg p-TSA/kg, respectively, with mean recoveries ranging from 76 to 79% (overall recovery range for all levels, 63-101%). No false-positive results were reported for the blank sample, and no interference was encountered by the presence of vanilla in samples.

Persistence behavior of chronic low back pain patients in an acute pain situation.

The test behavior of 24 chronic low back pain patients was compared with the behavior of 24 healthy control Ss., matched for age and sex, in an experimental, acute pain situation (cold pressor-test). Chronic low back pain patients showed poorer persistence behavior and reported more pain. Thus, elements of typical chronic low back pain behavior were also present in an acute pain situation. These findings are discussed within the framework of stimulus-generalization theory. In addition, the effect of different coping strategies on pain tolerance was reconfirmed. The chronic low back pain group and the control group did not cope differently.

Harvey A.K. Whitney lecture. The patient's pharmacist.

The concept of the patient's pharmacist, the clinical pharmacist who directs his efforts to the individual patient with prospective and concurrent drug use review, is discussed. A patient's pharmacist is familiar with the patient's medical and social history and his present health problems, and ensures that the patient's drug therapy is appropriate at all times. His knowledge base includes an understanding of the clinical use and actions of drugs, pharmacokinetics, optimum clinical response expected from drug therapy, monitoring and evaluating clinical response and communication skills for medication counseling. The patient information the pharmacist needs is discussed in detail. The pharmacist should record his patient care activities in the medical record; this record can serve as a basis for evaluating the pharmacist's activities.