Childhood tuberculosis (Part-I). Epidemiology, pathogenesis, clinical profile.

PIP: This paper focuses on the pathogenesis and clinical profile of tuberculosis (TB), a bacterial infection caused by Mycobacterium tuberculosis characterized by granuloma formation in infected tissues and by cell-mediated hypersensitivity. TB remains a major cause of morbidity and mortality worldwide and is the most common cause of death from a single infectious disease, particularly in children. Nearly 40 million children are likely to be exposed to the risk of TB and nearly 3-4 million children below age 5 years are estimated to be infected and may progress to disease. TB accounts for 10-15% of all pediatric deaths in a number of Indian hospitals. Factors such as low socioeconomic status, infections, drugs such as steroids, and age predisposes a person to TB. Childhood TB is classified as follows: 1) asymptomatic mantoux positive, 2) symptomatic mantoux positive, 3) primary pulmonary complex, 4) progressive pulmonary disease, 5) disseminated TB, 6) cervical and abdominal TB, 7) tubercular meningitis, 8) progressive bacillus Calmette-Guerin (BCG) disease, and 9) congenital tuberculosis. Among the various symptom complexes of childhood TB are failure to gain weight or weight loss, sudden onset of fever with erythema nodosum and phlyctenular conjunctivitis, failure to gain weight with respiratory wheezing. The direct and indirect impact of HIV infection on the development of TB in children is also discussed.^ieng

Childhood tuberculosis (part-II) (diagnosis and management).

PIP: This article focuses on the diagnosis and management of childhood tuberculosis (TB). Diagnostic tests for childhood TB can be classified into five groups: 1) intradermal skin tests; 2) mycobacterial detection and isolation; 3) immune diagnosis; 4) nonspecific tests; and 5) radiologic investigation. Of the intradermal skin tests, the Mantoux test is the most accurate, definitive, and reliable. The three diagnostic scoring systems discussed in this article are 1) WHO Provisional Guidelines for Diagnosis of TB in Children, 2) Udanis Simple Scoring Technique Criteria, and c) Kenneth Jones Scoring. Moreover, TB has been classified into five groups based on clinical types to optimize treatment protocol. These groups are presented in the article together with the treatment indications.^ieng

Mediation in labour relations.

The authors explain the concept of mediation, outline the mediator's multiple roles in resolving labour-relations disputes, and advocate the use of an innovative technique known as "Med-Arb". The latter combines mediation and voluntary arbitration in resolving collective bargaining impasses. The success of Med-Arb mediation depends upon the dispute's context, the history of past labour relations, and the mediator's expertise in employing suitable strategies. The authors also advocate further research into mediation and its relevance to the health care sector.

Poisoning in children.

This study is a retrospective analysis of 670 cases of poisoning (including phenothiazine toxicity) admitted to this hospital in the past six years, accounting for 0.9% of all pediatric admissions. Nearly half (45%) of the cases were in the age group of 1-4 years. Medicines and chemicals were the commonest agents (53%), followed by pesticides (15%), kerosene (11.2%), plant poisons (9.4%), food poisoning (3.9%) and corrosives (1.9%). Accidental poisoning was the commonest (70%) followed by iatrogenic (29.6%) and suicidal (0.4%). Overall mortality was 1.8%. Stress is laid on judicious use of phenothiazines as antiemetics and replacing them with drugs of lesser toxicity.

Bactericidal power of neutrophils in protein calorie malnutrition.

The present study was undertaken to compare the disturbance in bactericidal power of neutrophils in 25 children having protein caloric malnutrition age and sex matched healthy control subjects. There was a highly significant reduction in the percentage of bacteria killed during incubation in children having PCM as compared to healthy control. A direct relationship existed between total serum proteins and bactericidal activity of neutrophils in children having PCM. The impaired bactericidal power of neutrophils can be attributed to impaired synthesis of lysosomal enzymes, glycolytic activity of neutrophils in children having PCM. The exact mechanisms still remain to be elucidated. Decreased bactericidal activity of neutrophils may be one of the mechanisms responsible for infection.

Strategic management of technostress. The chaining of Prometheus.

The article proposes the concept of technostress and makes a strong recommendation for conducting research based on key researchable hypotheses. A conceptual framework of technostress is suggested to provide some focus to future research. A number of technostress management strategies are put forward, including strategic technological planning, organization culture development, technostress monitoring systems, and technouser self-development programs. The management of technostress is compared to the chaining of Prometheus, which, left uncontrolled, can create havoc in an organization. The authors believe that organizations have a responsibility to introduce, diffuse, and manage computer technology in such a way that it is congruent with the principles of sound, supportive, and humanistic management.