Cost-effectiveness of tuberculosis screening for migrant children in a low-incidence country.

Detection of latent tuberculous infection (LTBI) is important to prevent progression to active tuberculosis (TB), particularly in migrant children. We evaluated the cost-effectiveness of TB screening in migrant children in a low-incidence country. Retrospective analysis of a school-based TB screening programme in Switzerland. Migrant children were screened using the tuberculin skin test (TST). TST was considered positive if induration was 10 mm in non-bacille Calmette-Guérin (BCG) vaccinated children, and 15 mm in BCG-vaccinated children. Screening and treatment costs were extracted from hospital records. Cost impact was analysed as the difference between the cost of treatment for active TB and screening plus LTBI treatment. Cost per disability-adjusted life-years (DALY) was assessed based on Global Burden of Disease disability weight estimates. Of 1462 children screened, 1120 (77%; mean age 10.9 years; 46% female) underwent a TST. TST induration of 10 mm was documented in 78 (6.9%), and TST induration of 15 mm in 19 (1.6%). Twenty-one were TST-positive, and 17 children were diagnosed with LTBI; none had active TB. The highest rates of TST induration 10 mm were found in migrant children from Africa (16.6%) and Turkey (15.4%). Screening for LTBI was cost-effective if LTBI prevalence was 14%, with a progression rate of 5%; in case of lower LTBI prevalence, LTBI screening is cost-effective if progression rates to active TB are higher. School-based TB screening programmes targeting migrant children are cost-effective if populations with a relatively increased LTBI prevalence and/or high progression rates are included. .

[Prevalence of overweight and obesity in children and adolescents from 1977 to 2009 - examination of the school medical data of more than 94,000 school-age children in the city of Basel (Switzerland)]. / Prävalenz von Übergewicht und Adipositas bei Kindern und Jugendlichen von 1977 bis 2009 - Untersuchung schulärztlicher Daten von über 94 000 Schülerinnen und Schülern in Basel-Stadt (Schweiz).

OBJECTIVES: A cross-sectional study over a period of 30 years was used to investigate the development of overweight and obesity in school children. Of particular interest is the question of whether the overweight epidemic is continuing to increase, as often postulated, or whether a stagnation point or the start of a reversal of the trend has already been reached. METHODS: School medical examinations take place at three school levels in the city of Basel. 94,004 student files from these examinations from the school years 1977/78 and 1978/79, as well as from 1989/90 to 2008/09, have been subjected to a secondary analysis. The overweight and obesity prevalences were calculated for eleven 2-year cohorts according to the standards of the International Obesity Taskforce IOTF. A more in-depth analysis followed, differentiated by school grade, gender and nationality. RESULTS: The percentage of overweight and obese children and young people has increased strongly in the last 3 decades. Whereas every 11th child was overweight 30 years ago (9.3%), it now amounts to every 5th child (20.9%). The proportion of obese children has increased from 1.2% to 5.4%. The large increase in overweight and obesity prevalences mainly took place in the 1990s. Since the millennium change, the number of overweight and obese school children among those examined has only increased slightly, or has at least no longer increased. This general development was observed in all school grades and was independent of gender and nationality, although foreign children are always twice as likely to be affected by overweight and obesity. The stabilisation can be seen at its earliest and the change in trend is clearest in the kindergarten, which could indicate a "year's cohort effect". CONCLUSIONS: The development over the last 10 years is welcome from a public health point of view. The continued high prevalence still represents a significant health problem, however, and the prevention efforts being made against the overweight epidemic must be further strengthened.

[Sponge anesthesia with intraocular lidocaine application in cataract surgery]. / Sponge-Oberflächen-Anästhesie mit intracameraler Lidocain-Applikation. Kataraktchirurgie.

BACKGROUND: For cataract surgery in this country retro- and peribulbar anesthesia is the standard method. It totally stops eye movement as well as sensitivity to pain. Especially peribulbar anesthesia is known as a procedure with minimal complications, but the potential risks can be severe. In the past sponge anesthesia could not be used on patients with difficult cataract surgery due to the insufficient anesthetic effect. A modified anesthetic method is demonstrated for complicated cataract surgery. PATIENTS AND METHODS: In 281 non-selected, successive phacoemulsifications, all performed by the same surgeon, we applied sponge anesthesia and 1.5 mg midazolam as premedication. Only in cases of moderate and severe sensitivity was 1% 0.15 ml lidocaine applied intraocularly. The intensity of sensitivity was graded as 1 for low, 2 moderate, and 3 severe. RESULTS: Ninety eyes had complicated cataract surgery. Of the patients, 84.3% felt no pain during surgery; 11.4% were part of group 2 (moderate). Ten of 12 patients who had stated moderate sensitivity at first were free of pain after intraocular application of lidocaine, while the other 2 patients only felt minor sensitivity. CONCLUSION: The anesthetic procedure we present offers a safe alternative method to surgeons who are able to do surgical procedures on a mobile eye.

Evidence for the existence of galanin receptors on cultured astrocytes of rat CNS: colocalization with cholinergic receptors.

The cellular localization of binding sites for [125I]galanin was studied in explant cultures of rat neocortex, cerebellum, locus coeruleus and spinal cord by means by of autoradiography. Binding sites for the peptide were observed on a great number of astrocytes in all CNS regions studied. In addition to astrocytes, many neurones were intensely labelled by [125I]galanin. Binding of [125I]galanin (10(-8) M) to both astrocytes and neurones was markedly reduced or inhibited by the unlabelled peptide at high concentration (10(-6) M), suggesting 'specific' binding of the radioligand. Evidence for the colocalization of galanin and cholinergic receptors on astrocytes was provided by combined autoradiographic and immunohistochemical studies. Many astrocytes were labelled by [125I]galanin and immunostained with antibodies to either muscarinic or nicotinic receptors. Electrophysiological studies revealed that addition of galanin (10(-9) to 10(-7) M) to the bathing fluid caused a dose-dependent hyperpolarization of the majority of astrocytes studied. When galanin (10(-8) M) and the cholinergic agonists muscarine and nicotine (10(-6) M) were tested on the same astrocyte, all three compounds induced a hyperpolarization, suggesting a colocalization of functional galanin and cholinergic receptors on the glial membrane.

The relationship between parameters of serotonin metabolism and emetogenic potential of platinum-based chemotherapy regimens.

Evaluation of the relationship between parameters of serotonin (5-HT) metabolism and emesis in platinum-based chemotherapy. Female patients receiving chemotherapies containing either cisplatin (35 patients; 80 courses) or carboplatin (65 patients; 102 courses) were recruited. Recording of emesis and measurements of urinary 5-hydroxyindoleacetic acid (5-HIAA), the main metabolite of 5-HT, was performed over 3 days. Comparisons were performed for single-agent cisplatin (DDP) versus single-agent carboplatin (CBDCA), single-agent high-dose DDP (> or = 75 mg/m2) versus high-dose DDP combined with cyclophosphamide, high-dose versus low-dose DDP (< or = 50 mg/m2), and single-agent CBDCA versus a combination with alkylating agents. Cisplatin induced both a significantly higher frequency of emesis and a significantly higher increase of 5-HIAA excretion than carboplatin. The velocity of 5-HIAA increase may correlate better with emetogenic potential than peak 5-HIAA excretion levels. The increase of 5-HIAA excretion induced by cisplatin was limited to day 1. Higher cisplatin doses showed both a higher emetogenic potential and a more pronounced increase in urinary 5-HIAA on day 1. No significant difference was found when single-agent cisplatin was compared with cisplatin combined with cyclophosphamide. In contrast, a combination of carboplatin with alkylating agents induced a larger increase in urinary 5-HIAA and showed a higher emetogenic potential than single-agent carboplatin. Low-dose cisplatin induced less emesis than carboplatin combination therapy, but induced a larger increase in urinary 5-HIAA. Our findings provide evidence for a relationship between emetogenic potential and patterns of 5-HIAA excretion following platinum-based chemotherapy.

Action and binding of the endothelin antagonist bosentan on astrocytes of cultured rat central nervous system. Electrophysiological and autoradiographic studies.

Our autoradiographic studies demonstrate that astrocytes in explant cultures of rat central nervous system possess binding sites for the first orally active, mixed, nonpeptide endothelin receptor antagonist [3H] bosentan. Binding of [3H]bosentan was inhibited by unlabelled bosentan and endothelin-1 at high concentrations, suggesting specific binding of the antagonist. Electrophysiological studies have revealed that bosentan reversibly blocked the depolarizations by endothelin but not by angiotensin II, indicating that the antagonist specifically antagonizes the action of endothelin on the glial membrane. This is consistent with biochemical studies from other laboratories demonstrating that bosentan did not interfere with binding of angiotensin II. The availability of bosentan, a potent and selective endothelin receptor antagonist should help to elucidate the role of endothelin on astrocyte function.