Impact of the COVID-19 pandemic on tuberculosis national reference laboratory services in the WHO European Region, March to November 2020.

We assessed the impact of COVID-19 on diagnostic services for tuberculosis (TB) by national reference laboratories in the WHO European Region. Of 35 laboratories, 30 reported declines in TB sample numbers, amounting up to > 50% of the pre-COVID-19 volumes. Sixteen reported reagent or consumable shortages. Nineteen reallocated ressources to SARS-CoV-2 testing, resulting in an overall increase in workload, largely without a concomitant increase in personnel (n = 14). This poses a risk to meeting the 2025 milestones of the End TB Strategy

Diagnostic and prognostic value of noninvasive long-term video-electroencephalographic monitoring in epilepsy surgery: A systematic review and meta-analysis from the E-PILEPSY consortium

OBJECTIVE: The European Union–funded E‐PILEPSY network (now continuing within the European Reference Network for rare and complex epilepsies [EpiCARE]) aims to harmonize and optimize presurgical diagnostic procedures by creating and implementing evidence‐based guidelines across Europe. The present study evaluates the current evidence on the diagnostic accuracy of long‐term video‐electroencephalographic monitoring (LTM) in identifying the epileptogenic zone in epilepsy surgery candidates. METHODS: MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov were searched for relevant articles. First, we used random‐effects meta‐analytical models to calculate pooled estimates of sensitivity and specificity with respect to postsurgical seizure freedom. In a second phase, we analyzed individual patient data in an exploratory fashion, assessing diagnostic accuracy within lesional and nonlesional temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE) patients. We also evaluated seizure freedom rate in the presence of “localizing” or “nonlocalizing” LTM within each group. The quality of evidence was assessed using the QUADAS‐2 tool and the GRADE approach. RESULTS: Ninety‐four studies were eligible. Forty‐four were included in sensitivity meta‐analysis and 34 in specificity meta‐analysis. Pooled sensitivity was 0.70 (95% confidence interval [CI] = 0.60‐0.80) and specificity was 0.40 (95% CI = 0.27‐0.54). Subgroup analysis was based on individual data of 534 patients (41% men). In lesional TLE patients, sensitivity was 0.85 (95% CI = 0.81‐0.89) and specificity was −0.19 (95% CI = 0.13‐0.28). In lesional ETLE patients, a sensitivity of 0.47 (95% CI = 0.36‐0.58) and specificity of 0.35 (95% CI = 0.21‐0.53) were observed. In lesional TLE, if LTM was localizing and concordant with resection site, the seizure freedom rate was 247 of 333 (74%), whereas in lesional ETLE it was 34 of 56 (61%). The quality of evidence was assigned as “very low.” SIGNIFICANCE: Long‐term video‐electroencephalographic monitoring is associated with moderate sensitivity and low specificity in identification of the epileptogenic zone. Sensitivity is remarkably higher in lesional TLE compared to lesional ETLE. Substantial heterogeneity across the studies indicates the need for improved design and quality of reporting

Association between structural abnormalities and fMRI response in the amygdala in patients with temporal lobe epilepsy

AbstractObjectiveThe goal of this study was to investigate whether dysplastic amygdalae show an impaired response as revealed by functional MRI (fMRI).MethodsA fearful face fMRI paradigm using video sequences, as we have recently applied, was used in 25 patients with temporal lobe epilepsy (TLE): 24 had mesial TLE (14 right-, nine left-sided, one bilateral); one left lateral neocortical TLE. T1-, T2-weighted and fluid attenuated inversion recovery (FLAIR) MRI sequences were assessed for the detection and categorisation of structural amygdalar abnormalities according to size and MR signal intensity. Of the 25 patients, five patients had probable dysplastic amygdala (pDA): two right- and three left-sided.ResultsA fearful face paradigm led to significant amygdalar activation in all but one patient (p<0.05). In 15 (60%) of the patients amygdalar activation was found contralateral and in four (16%) ipsilateral to the side of seizure onset. Bilateral amygdalar activation was registered in five (20%) patients. In two patients with right-sided and one with left-sided pDA, fMRI activation was observed only in the contralateral amygdala. In two out of three patients with left-sided pDA we found significant ipislateral amygdalar fMRI-responses.ConclusionUnilateral pDA does not necessarily affect the amygdalar fMRI BOLD-response

Early COVID-19 pandemic's toll on tuberculosis services, WHO European Region, January to June 2020

BackgroundEssential health services, including for tuberculosis (TB), are being affected by public health and social measures (PHSM) introduced to control COVID-19. In many settings, TB resources, facilities and equipment are being redirected towards COVID-19 response.AimWe sought to assess the COVID-19 pandemic's impact on TB services in the World Health Organization (WHO) European Region.MethodsThe fifty-three European Region Member States were asked to report qualitative and quantitative data in quarter one and two (Q1 and Q2) 2020. TB notifications were triangulated with the severity score on domestic movement restrictions to assess how they may have influenced TB detection.ResultsTwenty-nine countries reported monthly TB notifications for the first half of 2019 and 2020. TB notifications decreased by 35.5% during Q2 2020 compared with Q2 2019, which is six-fold more than the average annual decrease of 5.1% documented during 2015-2019. The number of patients enrolled in rifampicin-resistant/multidrug-resistant TB treatment also decreased dramatically in Q2 2020, by 33.5%. The highest movement restriction severity score was observed between April and May 2020, which coincided with the highest observed decrease in TB notifications.ConclusionA decrease in TB detection and enrolment to treatment may cause increases in TB burden and threatens the Region's ability to reach the TB targets of the 2030 Sustainable Development Goals, still this might be mitigated with rapid restoration of TB services and the implementation of targeted interventions during periods with severe PHSM in place, such as those introduced in response to the COVID-19 pandemic

Emotion recognition and social cognition in juvenile myoclonic epilepsy

Juvenile myoklonische Epilepsie (JME) ist die am häufigsten auftretende idiopathische generalisierte Epilepsie. Die Erkrankung beginnt typischerweise in der Pubertät und ist häufig mit sozialen Anpassungsstörungen und Verhaltensauffälligkeiten, frontalen Dysfunktionen gleichend, assoziiert. Aktuelle bildgebende Studien bei Patienten mit JME beschreiben eine Assoziation zwischen Beeinträchtigungen von Emotionen und Verhalten mit strukturellen und funktionellen Veränderungen im frontalen Kortex und Thalamus. Bei Patienten mit Beeinträchtigung der Emotionsverarbeitung bzw. -regulation (wie z.B. bei bipolarer Erkrankung) wurden außerdem Störungen zwischen dem Regelkreis des limbischen Systems und dem frontalen Kortex beschrieben. Bis dato gibt es bei Patienten mit JME keine bildgebenden und neuropsychologischen Untersuchungen hinsichtlich des limbischen Systems und der Emotionsverarbeitung. Ziel der Studie ist es daher, dies unter verschiedenen Aspekten mittels funktioneller und struktureller Methoden darzustellen und ein einheitliches, auf neurobiologischen Erkenntnissen basierendes Konzept zu etablieren. Die Ergebnisse dieser Studie können wesentlich zur Entwicklung von psychologischen und pharmakologischen Strategien bei Patienten mit JME beitragen und damit zu eineJuvenile myoclonic epilepsy (JME) is the most common idiopathic generalized epilepsy. Disease onset is typically in puberty and poor social adjustment and behavioral disturbances, which resemble frontal lobe dysfunction, are often observed. In recent advanced brain imaging studies on JME patients, emotional and behavioral problems have been associated to subtle structural and functional alterations mainly in frontal cortex and thalamus. There is emerging evidence that patients with abnormal emotion processing and regulation, such as those with bipolar disorder, show disrupted connectivity between limbic structures and frontal cortices. There are no neuroimaging or neuropsychological studies related to emotion processing in patients with JME with a focus on limbic structures. We aimed to address the problem of emotional disturbances and social adjustment in JME patients from multiple aspects through thorough functional and structural assessment, which would potentially enable elaboration of a unifying concept explaining neurobiological background of disturbances in emotional processing and social adjustment in JME patients. Results of this study may potentially enable the development of psychological and pharmacological interventional strategies for managing behavioral disturbances in patients with JME.(VLID)433756

Highly luminescent and electrically conductive hybrid material

We proposed a highly luminescent and electrically conducting polymer composite material based on polylactide acid (PLA) polymer filled with reduced graphene oxide (RGO) or graphene oxide (GO) nanoplatelets covered by organic Eu(III) complexes tris-dibenzoylmethane mono-1,10-phenanthroline europium(III) [Eu(DBM)3Phen]. No Eu(DBM)3Phen luminescence quenching by RGO and GO nanoplatelets has been observed in emission decay. Partial luminescence intensity decrease is caused by graphene nanoplatelets absorption. Conductivity of the composite film is increased by more than five orders of magnitude as compared to the pure polymer. The proposed material is suitable for 3D printing technology and wide applications in optoelectronics

Diagnostic capacities for multidrug-resistant tuberculosis in the World Health Organization European region: action is needed by all member states

The World Health Organization (WHO) recently revised its guidelines for rapid diagnosis of drug-resistant tuberculosis (TB). This study aimed to investigate if TB reference diagnostic services are prepared to support these revisions. An online survey was performed among 44 TB National Reference Laboratories (NRLs) in the WHO European Region. Questions addressed the use of WHO-recommended molecular techniques for the diagnosis of drug-resistant TB, the techniques applied to investigate antimicrobial resistance, and questions on quality assurance. Among 35 of 44 (80%) participating NRLs, 29 of 35 (83%) reported using the GeneXpert platform as the initial test to detect Mycobacterium tuberculosis complex and rifampicin resistance. Five laboratories reported using another WHO-recommended, moderate-complexity, automated nucleic acid amplification test for detection of Mycobacterium tuberculosis complex and resistance to rifampicin and isoniazid. Most (32 of 35; 91%) NRLs reported the capacity to test second-line drugs that have been in clinical use for many years (fluoroquinolones, linezolid, and injectable agents). Only 23 of 35 (66%) and 21 of 35 (60%) NRLs reported the capacity to test bedaquiline and clofazimine. Further efforts will be needed to improve the availability of quality-controlled testing against WHO Group A and Group B drugs. Earlier considerations on the scale-up of diagnostic capacities should be enforced as part of future approval processes for new antimycobacterial agents