The Identification of Children with,or at Significant Risk of,Intellectual Disabilities in Low‐ and Middle‐Income Countries: A Review

Background Developmental monitoring of children is an important strategy for the early detection and management of intellectual disabilities (ID) in high‐income countries. This review summarizes the literature on identifying children with ID in low‐ and middle‐income (LAMI) countries. Materials and methods Electronic literature database searches were conducted to identify articles in the English language published since 1990 relating to the identification of children with, or at risk of, ID in LAMI countries. Requests for information were also sent to the membership of International Association for the Scientific Study of Intellectual Disabilities and relevant organizations in selected LAMI countries. Results A total of 37 articles were identified for inclusion in the review, the majority of which concerned validation of specific screening tools. Information is presented on sensitivity, specificity, positive predictive value, negative predictive value and reliability of identified screening tools. Conclusion Studies were mainly concerned with identifying child disability. Research and development should develop specific approaches to identifying ID among children in LAMI countries.     

Challenges and Strategies in Serving the Uninsured in Nashville, Tennessee

The patient-centered medical home (PCMH) is being promoted as a cornerstone for transforming primary care. Physician organizations (POs) are playing a more prominent role by facilitating practices' transformation to PCMH. Using a framework of organizational integration, we investigate the changing relationship between POs and practices through qualitative interviews. Through increased integration, POs can support both the big-picture and day-to-day activities of practice transformation. Most PO-practice unit connections reflected new areas of engagement-competencies that POs were not developing in the past-that are proving integral to the broad-scale practice change of PCMH implementation.     

Endoscopic treatment of esthesioneuroblastoma

Esthesioneuroblastoma is an uncommon malignant tumor of the nasal vault. Treatment consists of craniofacial resection. As endoscopic techniques have advanced, this approach has been recommended to avoid morbidity and to reduce costs.AimTo evaluate outcomes in patients with esthesioneuroblastoma treated by an endoscopic technique.MethodsA prospective study of patients diagnosed with esthesioneuroblatoma and treated by an endoscopic technique. The literature over the past 20 years was reviewed for an update on the pathology.ResultsWe present 4 patients, 3 males and 1 female, staged according to Kadish and Dulguerov. All were treated surgically with endoscopic techniques, followed by radiotherapy. One patient was also submitted to neck dissection and chemotherapy because of regional metastasis. There were no significant postoperative complications. The mean hospital stay was 3 days; one patient stayed in the ICU for 24 hours after surgery. Follow-up is recent; so far there are no recurrences.ConclusionEsthesioneuroblastoma is a potentially curable malignancy. Endoscopic techniques help reduce hospital costs and decrease the morbidity. Adequate margins of healthy tissue are obtained with endoscopic resection, as with craniofacial resection. The literature suggests that outcomes after endoscopic resection are similar to those of the conventional external approach.     

Efficacy of monoclonal antibody against tumor necrosis factor alpha in an endotoxemic baboon model.

Tumor necrosis factor alpha (TNF) has been described as a primary mediator of the pathophysiology associated with bacterial sepsis/endotoxemia. We tested the efficacy and possible mechanisms of protection of a monoclonal antibody against TNF (TNF Mab) in a low mortality (29%), endotoxemic baboon model. A number of parameters were monitored at days 0, 1, 2 and 5-7 after challenge with 2 mg E. coli endotoxin/kg. TNF Mab pretreatment (15 mg/kg) prevented the increase in detectable serum TNF and the early perturbations in cardiovascular function which occurred in the control group. Early metabolic dysfunction was delayed in the TNF MAb group and was attenuated thereafter. Dysfunction of the kidney, liver, and coagulation systems and the increased IL-6 levels were significantly attenuated in the TNF MAb group; neutrophil activation was not affected by TNF MAb. No deaths occurred in the TNF MAb group. These results support the hypothesis that TNF plays a central role in the pathophysiology of endotoxic shock.     

Epizootic vesicular stomatitis in Colorado, 1982: infection in occupational risk groups

In 1982-1983, an epizootic of vesicular stomatitis occurred in the western United States. Veterinarians, research workers, and regulatory personnel who were exposed to vesicular stomatitis virus were examined for patterns of human infection and prevalence of vesicular stomatitis New Jersey serotype neutralizing antibody. Insight into the mechanism of transmission was sought by comparing activities of antibody-positive and antibody-negative persons. A statistically significant risk factor was a history of infected animals sneezing in the face of serosurvey participants. Elevated odds ratios were also calculated for those who usually examined the oral cavity of affected animals, had open wounds on hands or arms, and had exposure to saliva through the eye or skin. Relatively intimate direct contact was required; a higher risk was associated with examining horses than cattle. Neutralizing antibody prevalence was significantly higher among exposed persons with illness (23%) than in exposed persons without a history of clinical illness (7%). Overall, however, infectivity of VSNJ for humans during the epizootic was low.     

Neuropeptide Y1 and Y5 receptors mediate the effects of neuropeptide Y on the hypothalamic-pituitary-thyroid axis

Neuropeptide Y (NPY) is one of the most important hypothalamic-derived neuropeptides mediating the effects of leptin on energy homeostasis. Central administration of NPY not only markedly stimulates food intake, but simultaneously inhibits the hypothalamic-pituitary-thyroid axis (HPT axis), replicating the central hypothyroid state associated with fasting. To identify the specific NPY receptor subtypes involved in the action of NPY on the HPT axis, we studied the effects of the highly selective Y1 ([Phe7,Pro34]pNPY) and Y5 ([chicken pancreatic polypeptide(1-7), NPY(19-23), Ala31, Aib32 (aminoisobutyric acid), Q34]human pancreatic polypeptide) receptor agonists on circulating thyroid hormone levels and proTRH mRNA in hypophysiotropic neurons of the hypothalamic paraventricular nucleus. The peptides were administered continuously by osmotic minipump into the cerebrospinal fluid (CSF) over 3 d in ad libitum-fed animals and animals pair-fed to artificial CSF (aCSF)-infused controls. Both Y1 and Y5 receptor agonists nearly doubled food intake compared with that of control animals receiving aCSF, similar to the effect observed for NPY. NPY, Y1, and Y5 receptor agonist administration suppressed circulating levels of thyroid hormones (T3 and T4) and resulted in inappropriately normal or low TSH levels. These alterations were also associated with significant suppression of proTRH mRNA in the paraventricular nucleus, particularly in the Y1 receptor agonist-infused group [aCSF, NPY, Y1, and Y5 (density units +/- SEM), 97.2 +/- 8.6, 39.6 +/- 8.4, 19.9 +/- 1.9, and 44.6 +/- 8.4]. No significant differences in thyroid hormone levels, TSH, or proTRH mRNA were observed between the agonist-infused FSanimals eating ad libitum and the agonist-infused animals pair-fed with vehicle-treated controls. These data confirm the importance of both Y1 and Y5 receptors in the NPY-mediated increase in food consumption and demonstrate that both Y1 and Y5 receptors can mediate the inhibitory effects of NPY on the HPT axis.     

Neuropeptide Y has a central inhibitory action on the hypothalamic-pituitary-thyroid axis

Recent evidence suggests that neuropeptide Y (NPY), originating in neurons in the hypothalamic arcuate nucleus, is an important mediator of the effects of leptin on the central nervous system. As these NPY neurons innervate hypophysiotropic neurons in the hypothalamic paraventricular nucleus (PVN) that produce the tripeptide, TRH, we raised the possibility that NPY may be responsible for resetting of the hypothalamic-pituitary-thyroid (HPT) axis during fasting. To test this hypothesis, the effects of intracerebroventricularly administered NPY on circulating thyroid hormone levels and proTRH messenger RNA in the PVN were studied by RIA and in situ hybridization histochemistry, respectively. NPY administration suppressed circulating levels of thyroid hormone (T(3) and T(4)) and resulted in an inappropriately normal or low TSH. These alterations were associated with a significant suppression of proTRH messenger RNA in the PVN, indicating that NPY infusion had resulted in a state of central hypothyroidism. Similar observations were made in NPY-infused animals pair fed to the vehicle-treated controls. These data are reminiscent of the effect of fasting on the thyroid axis and indicate that NPY may play a major role in the inhibition of HPT axis during fasting.