Economic evaluations of diagnosis and treatment programmes for tuberculosis in developing countries: a review

This paper reviews recent economic evaluations of diagnostic pathways and treatments of TB in poorly resourced and highly burdened countries. The limited number of studies and their methodological weaknesses make it difficult to draw strong policy conclusions, especially in the field of diagnosis. The evidence points to a possible gain in cost-efficiency by moving from the Ziehl-Neelsen staining method to fluorescence microscopy and from three to two sputum examinations. Nevertheless, further research is indispensable. Concerning treatment, the community-based DOTS approach has proved more cost-effective than the conventional approach. With respect to other treatment alternatives, less evidence is available, but two promising possibilities are the expansion of DOTS by collaboration with the private sector and the introduction of second-line drugs for chronic disease

Bone mineral density in children and adolescents: relation to puberty, calcium intake, and physical activity

The association of height, weight, pubertal stage, calcium intake, and physical activity with bone mineral density (BMD) was evaluated in 500 children and adolescents (205 boys and 295 girls), aged 4-20 yr. The BMD (grams per cm2) of lumbar spine and total body was measured with dual energy x-ray absorptiometry. Lumbar spine volumetric BMD was calculated to correct for bone size. BMD and volumetric BMD increased with age. During puberty, the age-dependent increment was higher. After adjustment for age, the Tanner stage was significantly associated with all three BMD variables in girls and with spinal BMD in boys. In boys, positive correlations were found between BMD and both calcium intake and physical activity after adjustment for age. Stepwise regression analysis with weight, height, Tanner stage, calcium intake, and physical activity as determinants with adjustment for age resulted in a model with Tanner stage in girls and weight in boys for all three BMD variables. The major independent determinant of BMD was the Tanner stage in girls and weight in boys

Methylphenidate and the Response to Growth Hormone Treatment in Short Children Born Small for Gestational Age

Background: Growth hormone (GH) treatment has become a frequently applied growth promoting therapy in short children born small for gestational age (SGA). Children born SGA have a higher risk of developing attention deficit hyperactivity disorder (ADHD). Treatment of ADHD with methylphenidate (MP) has greatly increased in recent years, therefore more children are being treated with GH and MP simultaneously. Some studies have found an association between MP treatment and growth deceleration, but data are contradictory. Objective: To explore the effects of MP treatment on growth in GH-treated short SGA children Methods: Anthropometric measurements were performed in 78 GH-treated short SGA children (mean age 10.6 yr), 39 of whom were also treated with MP (SGA-GH/MP). The SGA-GH/MP group was compared to 39 SGA-GH treated subjects. They were matched for sex, age and height at start of GH, height SDS at start of MP treatment and target height SDS. Serum insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) levels were yearly determined. Growth, serum IGF-I and IGFBP-3 levels during the first three years of treatment were analyzed using repeated measures regression analysis. Results: The SGA-GH/MP group had a lower height gain during the first 3 years than the SGA-GH subjects, only significant between 6 and 12 months of MP treatment. After 3 years of MP treatment, the height gain was 0.2 SDS (±0.1 SD) lower in the SGA-GH/MP group (P = 0.17). Adult height was not significantly different between the SGA-GH/MP and SGA-GH group (-1.9 SDS and -1.9 SDS respectively, P = 0.46). Moreover, during the first 3 years of MP treatment IGF-I and IGFBP-3 measurements were similar in both groups. Conclusion: MP has some negative effect on growth during the first years in short SGA children treated with GH, but adult height is not affected

Antifungal rhizosphere bacteria can increase as response to the presence of saprotrophic fungi

Acknowledgments: Funding was provided by the Netherlands Organisation for Scientific Research (NWO) in the form of a personal Veni grant to A.v.d.W. This is publication number 5923 of the NIOO-KNAW Netherlands Institute of Ecology. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Verbetert paracetamol het herstel na een beroerte?

An increase in body temperature in the first days following stroke is related to poor functional outcome. High-dose paracetamol (acetaminophen) reduces the body temperature by 0.3°C and can prevent fever. Paracetamol treatment is simple, cheap and has few side effects. In the first "Paracetamol (Acetaminophen) in Stroke" (PAIS) study, there was a beneficial effect of high-dose paracetamol on functional outcome in patients with stroke and a body temperature of 37.0°C or above. Because this result was found in a subgroup analysis, a new study is needed to confirm this finding. Recently the randomised PAIS 2 study was initiated. This study aims to assess the effect of high-dose paracetamol on functional outcome in patients with acute stoke and a body temperature of 37.0°C or above.Een stijging van de lichaamstemperatuur in de eerste dagen na een beroerte is geassocieerd met een slechte prognose. Hoge dosis paracetamol verlaagt de lichaamstemperatuur gemiddeld met 0,3°C en kan koorts voorkómen. Behandeling met paracetamol is eenvoudig, zeer goedkoop en heeft weinig bijwerkingen. In het eerste ‘Paracetamol (Acetaminophen) in Stroke’(PAIS)-onderzoek verbeterde vroege behandeling met een hoge dosis paracetamol de functionele uitkomst van patiënten met een beroerte en een lichaamstemperatuur van 37,0°C of hoger. Dit effect werd echter gevonden in een subgroepanalyse en dient daarom nader te worden onderzocht. Recentelijk is het gerandomiseerde onderzoek PAIS 2 gestart. Hierin wordt het effect bestudeerd van behandeling met een hoge dosis paracetamol op functioneel herstel bij patiënten met een lichaamstemperatuur van 37,0°C of hoger in de acute fase van een beroerte

Dupilumab shows long-term effectiveness in a large cohort of treatment-refractory atopic dermatitis patients in daily practice:52-Week results from the Dutch BioDay registry

Background Real-life data on long-term effectiveness and safety of dupilumab in atopic dermatitis patients are limited. Objective To study 52-week effectiveness and safety of dupilumab in a prospective multicenter cohort of adult patients with treatment-refractory atopic dermatitis. Methods Patients treated with dupilumab and participating in the Dutch BioDay registry were included. Clinical effectiveness and safety were evaluated. Results Two hundred ten atopic dermatitis patients were included. Mean percentage change in Eczema Area and Severity Index score after 16 weeks was –70.0% (standard deviation 33.2%) and further decreased to –76.6% (standard deviation 30.6%) by week 52. A greater than or equal to 75% improvement in the score was achieved by 59.9% of individuals by week 16 and by 70.3% by week 52. The most reported adverse effect was conjunctivitis (34%). Limited patients (17; 8.1%) discontinued dupilumab treatment. Limitations Because of the lack of a control group and observational design, factors of bias may have been induced. Conclusion Treatment with dupilumab resulted in a rapid improvement in clinical outcome measures, and effectiveness further improved during the 52-week follow-up period