Pediatric tuberculosis in Italian children: Epidemiological and clinical data from the Italian register of pediatric tuberculosis

Tuberculosis (TB) is one of the leading causes of death worldwide. Over the last decades, TB has also emerged in the pediatric population. Epidemiologic data of childhood TB are still limited and there is an urgent need of more data on very large cohorts. A multicenter study was conducted in 27 pediatric hospitals, pediatric wards, and public health centers in Italy using a standardized form, covering the period of time between 1 January 2010 and 31 December 2012. Children with active TB, latent TB, and those recently exposed to TB or recently adopted/immigrated from a high TB incidence country were enrolled. Overall, 4234 children were included; 554 (13.1%) children had active TB, 594 (14.0%) latent TB and 3086 (72.9%) were uninfected. Among children with active TB, 481 (86.8%) patients had pulmonary TB. The treatment of active TB cases was known for 96.4% (n = 534) of the cases. Overall, 210 (39.3%) out of these 534 children were treated with three and 216 (40.4%) with four first-line drugs. Second-line drugs where used in 87 (16.3%) children with active TB. Drug-resistant strains of Mycobacterium tuberculosis were reported in 39 (7%) children. Improving the surveillance of childhood TB is important for public health care workers and pediatricians. A non-negligible proportion of children had drug-resistant TB and was treated with second-line drugs, most of which are off-label in the pediatric age. Future efforts should concentrate on improving active surveillance, diagnostic tools, and the availability of antitubercular pediatric formulations, also in low-endemic countries

Abdominal Tuberculosis in Children: A Case Series of Five Patients

: Tuberculosis remains (TB) to be one of the most common causes of child morbidity and mortality. Abdominal TB is not frequently diagnosed and, although its incidence is not definitively established, there are data that seem to indicate that it accounts for approximately 1-3% of all pediatric TB cases and for no more than 10% of those with extrapulmonary manifestations. It seems, however, that abdominal TB is significantly more common than usually thought as signs and symptoms are non-specific and may mimic other diseases. The delayed or wrong diagnosis of pediatric abdominal TB can have dramatic consequences as they can lead to untreated TB with miliary dissemination, unnecessary surgery, or dangerous drug therapies. This report describes five cases of abdominal TB diagnosed among 216 pediatric patients admitted for TB in Italy from 2011 to 2021. Our cases evidence that abdominal TB is a complex and potentially very severe disease that, when not appropriately diagnosed, may be associated with severe complications and prolonged anti-TB therapy. Discussion among specialists is crucial to achieve an early diagnosis and to promptly start the anti-TB treatment. Further studies are needed to clarify the appropriate duration of therapy as well as management of MDR abdominal TB cases

Multispectral imaging as digital restoration tool for faded inks on manuscripts. Three cases of study of degraded written parchments by means of non-destructive techniques

In the study of manuscripts, the scientific researches are generally oriented to the chemical analysis of the inks, parchments or papers and restoration materials and, only in last 15 years, the application of multispectral imaging appears in the scientific literature. Multispectral Imaging has been developed by combining digital imaging and spectroscopy. The multispectral imaging shows higher performance then a color digital camera due to the fact that reveals light portions and/or infrared wavelengths that cannot be detected by the human eye. The spectral images may aid paleographers to read old scripts by enhancing the contrast between the under-and-overwriting or inks that are partially or completely disappeared. We present a non-destructive study of three written parchments, partially degraded, stored at Library of Department of History, Cultures and Religions at Sapienza-University (Rome): “Provvisorio 34 bis 8839/c” (XIV century), “Provvisorio 37 8839/o e 8839/t” ( XIV secolo ) and “Provvisorio 38”(containing a Filocolo fragment by Giovanni Boccaccio). The manuscripts have been analyzed by means of X-ray Fluorescence (XRF), Attenuated Total Reflection Fourier Transform Infrared Spectroscopy (ATR-FTIR), reflectance spectroscopy, multispectral UV fluorescence imaging, VIS-NIR multispectral imaging and radiography. The three manuscripts have been written with iron gall inks, while the capital letters have been realized with cinnabar (or vermillion) and azurite. The presence of gypsum on some areas of the parchment of the “Provvisiorio 34” indicates that the sulphate ions of the ink are migrated in the support. By illuminating the manuscripts with visible sources, the acquisition of multispectral images with narrow interferential filters, permits the maximization of the contrast between the inks and the parchment leading to read the leaching areas of the manuscripts. With the same approach, by exciting with UV lamps, it is possible to read faded inks, by exploiting the fluorescence phenomenon of the parchments and, in general, of the organic matters. Moreover, the radiography technique was employed to verify the possibility to read inside multilayer structures, as overlapping written parchments, demonstrating that red capital letter (containing elements of high-atomic number) are detectable

Behavioural and EEG effects of chronic rapamycin treatment in a mouse model of tuberous sclerosis complex

Tuberous Sclerosis Complex (TSC) is a multisystem genetic disorder caused by mutation in either Tsc1 or Tsc2 genes that leads to the hyper activation of the mTOR pathway, a key signalling pathway for synaptic plasticity. TSC is characterized by benign tumors arising in different organs and severe neuropsychiatric symptoms, such as epilepsy, intellectual disability, autism, anxiety and depressive behaviour. Rapamycin is a potent inhibitor of mTOR and its efficacy in treating epilepsy and neurological symptoms remains elusive. In a mouse model in which Tsc1 has been deleted in embryonic telencephalic neural stem cells, we analyzed anxiety- and depression-like behaviour by elevated-plus maze (EPM), open-field test (OFT), forced-swim test (FST) and tail-suspension test (TST), after chronic administration of rapamycin. In addition, spectral analysis of background EEG was performed. Rapamycin-treated mutant mice displayed a reduction in anxiety- and depression-like phenotype, as shown by the EPM/OFT and FST, respectively. These results were inline with EEG power spectra outcomes. The same effects of rapamycin were observed in wild-type mice. Notably, in heterozygous animals we did not observe any EEG and/or behavioural variation after rapamycin treatment. Together these results suggest that both TSC1 deletion and chronic rapamycin treatment might have a role in modulating behaviour and brain activity, and point out to the potential usefulness of background EEG analysis in tracking brain dysfunction in parallel with behavioural testing. (c) 2012 Elsevier Ltd. All rights reserved