Early Case Detection Research Articles

Abstract 4119426: Enhancing early detection of ICI myocarditis cases during hospitalization: A role for large language models

Background: Immune-checkpoint inhibitor (ICI)-induced myocarditis is the most fatal immune-related adverse event (irAE). Early recognition and treatment of ICI myocarditis is associated with improved outcomes. However, current approaches to the diagnosis of ICI myocarditis have limitations. Open-source large language models (LLMs) are an accessible and scalable method of answering queries from human-generated text, and therefore may assist in the real-time early detection of ICI myocarditis among at-risk patients. Research Question: Can a free, open-source LLM detect cases of ICI myocarditis early in admission? Aims: We investigated the ability of a LLM pipeline to screen for ICI myocarditis within one day of admission using hospital medical records. Methods: Hospital admissions of patients on ICI therapy from November 4th, 2021, to September 5th, 2023 were retrospectively reviewed by a multidisciplinary immunotoxicity team using established, published definitions for the presence of ICI myocarditis. Progress notes written the day before, day of, and day after admission were fed into an open-source LLM pipeline built using Mistral 7B OpenOrca with retrieval augmentation generation (RAG). Performance of the LLM was measured via sensitivity and specificity in comparison to the gold standard of manual adjudication. Results: Of the 1874 hospital admissions of patients on ICI therapy, there were 22 (1.2%) cases of myocarditis. The average time to initiation of treatment was 2.45 days. Using notes written within one day after admission, the LLM detected ICI myocarditis with 95.5±8.7% sensitivity and 95.4±1.0% specificity, spending 2.13 seconds per chart. Conclusion: LLMs serve as a useful tool to screen for ICI myocarditis, detecting 95.5% of cases within one day of admission with 95.4% specificity. Future studies will investigate if integrating this tool into the real-time management of irAEs could lead to earlier diagnosis, faster initiation of treatment, and improved patient outcomes.

Clinical characteristics of COVID-19 patients admitted to the intensive care unit of the largest public-sector hospital in Karachi: A retrospective, observational study.

Objective: To characterize the clinical features of critically ill COVID-19 patients admitted to COVID-ICU and describe their outcomes. Study Design: Retrospective Observational study. Setting: Dr. Ruth K. M. Pfau Civil Hospital Karachi, Pakistan. Period: May 2020 to September 2021. Methods: The study aimed to investigate the clinical characteristics and outcomes of patients with confirmed or suspected COVID-19 who were admitted to the ICU. Patients in the study period confirmed or suspected COVID-19, admitted to the ICU for more than 24 hours, and committed to full treatment were included this study. Patients with COVID-19 discharged or died within 24 hours of admission were excluded. Results: The most commonly observed symptoms among the patients were shortness of breath (92.5%), fever (91.2%), cough without sputum (39.2%), altered consciousness (11.9%), and muscle aches (8.8%). Acute respiratory distress syndrome (ARDS) was identified as the most prevalent complication among COVID-19 patients, impacting 40.8% of the study population. A significant proportion of COVID-19 patients required mechanical ventilation and cardiac support. Specifically, (41.4%) of the patients required invasive mechanical ventilation, (47.4%) required non-invasive ventilation, and (26.3%) received cardiac support. Laboratory assessment showed that platelet counts varied significantly between survivors and non-survivors, with non-survivors exhibiting lower platelet counts. Gender differences were also observed among COVID-19 patients by age, with males having a higher mean age than females in all age categories, and the difference was statistically significant (p < 0.001) in all age categories except for the 30-44 years age category (p = 0.087). Age-wise recovery and mortality rates were analyzed, and the results showed that among both deceased and recovered patients, the proportion of deceased patients increased with age, while the proportion of recovered patients increased until the age range of 45-59 years for both males and females. The study found that 136 of the patients survived while 275 of the patients succumbed to the disease. Among the survivors, (31.3%) were male, and (36.2%) were female. Conclusion: The study emphasizes the importance of monitoring patients for potential complications and providing them with supportive care. Early detection and management of severe cases of COVID-19 are critical in preventing complications and improving patient outcomes.

The Treatment Outcomes of Tuberculosis Patients at Adare General Hospital, Southern Ethiopia (A Five-Year Retrospective Study)

Ethiopia is among the countries most heavily affected by tuberculosis, where it is the leading cause of morbidity, the third cause of hospital admission and the second cause of death. To improve tuberculosis management and control, the early detection of cases, effective treatment and the persistent evaluation of treatment outcomes are vital issues that should be taken into consideration. This study was designed to determine the treatment outcomes and associated risk factors among TB patients registered at Adare General Hospital in Southern Ethiopia. A five-year retrospective study was conducted by reviewing the files of the TB patients registered from September 2013 to August 2017. The data were coded, cleaned, entered and analyzed using SPSS version 20 statistical software. Bivariate and multivariable logistic regression with odds ratios (OR) along with a 95% confidence interval was computed and interpreted. A p-value < 0.05 was declared as statistically significant. Among the 1122 cases, 620 (55.3%) were male, 748 (66.7%) were from urban areas, 319 (28.4%) were smear positive, 352 (31.4%) were smear negative and 451 (40.2%) were extra-pulmonary patients. Among the treated patients, 284 were declared cured, 753 completed their treatment, 29 were defaulters, 3 failed to follow up, and 53 died. The overall treatment success rate was 92.4%. The TB patients from urban areas (AOR = 1.44, 95% CI: 0.28, 0.67), and the HIV-negative TB patients (AOR = 5.48, 95% CI; 3.474, 8.64) were significantly associated with successful treatment outcomes. The treatment success rates of tuberculosis at Adare General Hospital were comparable to the national health facility-level coverage, but they should be maintained and strengthened further to attain tuberculosis-related national and millennium goals.

Assessment of risk of developing diabetes mellitus using Indian diabetes risk score (IDRS) among adult population living in an urban field practice area

ABSTRACT Background: The Indian Diabetes Risk Score (IDRS) is a simple and cost-effective tool for the early detection of undiagnosed cases in the community and is most suited for the Indian population to assess the risk of developing diabetes. Aim and Objectives: To assess the risk of Type 2 Diabetes Mellitus among the adult population living in an urban area by using the Indian Diabetes Risk Score (IDRS). To determine associated risk factors among the study population. Materials and Methods: A community-based cross-sectional study was done among 145 adults in an Urban field practice area under the Department of Community Medicine, Andhra, Medical College, Visakhapatnam. All males and females aged between 20 and 60 years living in the urban field practice area for the past year or more. The known diabetics and severely ill patients were excluded. Ethical permission was obtained and informed consent was taken from all the study participants. Results: Out of 145 study population, 66 people (45.5%) were found to be at the low-risk category, 41 people (28.3%) were in the medium-risk category and 38 people (26.2%) were at high risk based on their IDRS scores. Conclusion: The study showed a statistically significant relationship between factors such as gender, age, increased waist circumference, family history of diabetes mellitus, physical activity, and increased risk score.

Measles cluster in Northern Portugal: enhancing surveillance strengths

Abstract Although measles was declared eliminated in Portugal in 2015, outbreaks persist, despite high vaccination coverage. The last outbreak in the northern region was in 2017. Portugal has a Surveillance System implemented for mandatory communicable diseases (SINAVE) integrating clinical, epidemiological and laboratory data. In 2021, WHO expressed concern about the low sensitivity of measles surveillance and urged Portugal to strengthen its surveillance practices. Our study aims to describe a measles cluster in northern Portugal during the first trimester of 2024. Data from measles cases from the first trimester of 2024 were collected from SINAVE. Contact tracing and Public Health (PH) intervention data was sent by Local Public Health Authorities through a survey designed for that purpose. A total of 70 suspected cases were reported and investigated: 6 cases were laboratory confirmed and 64 were discarded. The confirmed cases had a mean age of 28 years (all adults), with 50% female. The mean notification time was 0,3 days. The index case was imported (Mauritania) and unvaccinated, leading to 2 secondary cases. Five cases had 2 doses of a measles vaccine, with 1 case being a health professional. Additionally, 1 case was imported from France. For 2 cases the source of infection could not be unequivocally identified and no travel history during incubation period. A total of 851 contacts of confirmed cases were identified. Although sustainable transmission is not evident in our region, measles is being introduced through migration and tourism. Despite clinical awareness, strengthening early case detection is essential to enforce effective control measures. PH teams have been working tirelessly to trace clusters origins, gathering large number of contacts and adapting strategies for sustained control. In a globalized world, ensuring surveillance sensitivity is paramount. Integrating other data sources in surveillance routine is crucial for upholding Measles-Free Status compliance. Key messages • Measles must take centre stage on our agenda. • Reinforcing surveillance, integrating additional data sources, is crucial for heightened sensitivity and prompt response.

New approaches to standard of care in early-phase myeloproliferative neoplasms: can interferon-α alter the natural history of the disease?

The classical BCR::ABL-negative myeloproliferative neoplasms (MPN) include Polycythemia Vera (PV), Essential Thrombocytemia (ET), and Primary Myelofibrosis (PMF). They are acquired clonal disorders of the hematopoietic stem cells (HSC) leading to hyperplasia of one or several myeloid lineages. MPN are caused by three main recurrent mutations, JAK2V617F and mutations in the calreticulin (CALR) and the thrombopoietin receptor (MPL) genes. Here, we review the general diagnosis, the complications, and the management of MPN. Second, we explain the physiopathology of the natural disease development and its regulation, which contributes to MPN heterogeneity. Thirdly, we describe the new paradigm of the MPN development highlighting the early origin of driver mutations decades before the onset of symptoms and the consequence on early detection of MPN cases in the general population for early diagnosis and better medical management. Finally, we present the interferon alpha (IFNα) therapy as a potential early disease-modifying drug after reporting its good hematological and molecular efficacies in ET, PV and early MF in clinical trials as well as its mechanism of action in pre-clinical studies. As a result, we may expect that, in the future, MPN patients will be diagnosed very early during the course of disease and that new selective therapies under development, such as IFNα, JAK2V617F inhibitors and CALRmut monoclonal antibodies, would be able to intercept the mutated clones.

Community case study for surveillance and early case-detection of SARS-CoV-2 infections across high-risk key populations: the Sentinella programme.

At the beginning of the COVID-19 pandemic, an ad hoc organisational framework was established between academic, local government and community partners to implement the "Sentinella - Identify, Trace and Prevent" screening programme in Verona, north-east Italy. Between September 2020 and May 2021, key populations not covered by any screening policies at the local and national level were screened for SARS-CoV-2. Target populations were: older adult residents (males >65 years and females >75 years), bus and taxi drivers, social workers, supermarket employees, hospital cleaning and catering staff, researchers working in the local hospitals, students, and people experiencing homelessness (PEH). Five dedicated swab clinics, home testing facilities, and one mobile clinic were activated to collect nasopharyngeal swabs. Molecular analysis was performed for all the subjects; an antigen-rapid diagnostic test (Ag-RDT) was also implemented as a point-of-care test for PEH. Medical follow-up, psychological support, and quarantine facilities were organised for subjects who tested positive for SARS-CoV-2. Overall, 2075 subjects participated in the surveillance programme. Amongst these, 1,572 were residents/workers, whilst 503 were PEH. A total of 127 (6.2%) participants tested positive for SARS-CoV-2. Sixty-nine were residents, 58 PEH. The incidence rate was 4 per 10.000 person/day (95% CI 3.1-5.0). The highest prevalence and incidence rates were found amongst supermarket employees (9.7% and 8.5 per 10.000 person/day, 95% CI 3.81-18.86, respectively), followed by hospital cleaning staff (8.1%, 7.6 per 10.000 person/day, CI 95% 4.9-11.7). Regarding PEH, the prevalence of SARS-CoV-2 was 11.5%. All PEH identified as positive were isolated in dedicated shelter facilities. Amongst the 69 residents/workers who were quarantined, 53 were reached for initial psychological support for assessing the presence of any psychological distress or psychiatric pathology. Amongst the subjects evaluated, 10 (18.9%) presented clinically significant psychological discomfort and accessed the stepped-care psychological intervention. The community partnerships played a pivotal role in optimising early case detection. Promotion of testing helped to prevent and contain more efficiently potential clusters through strategic planning, especially for PEH. Insights from the study highlight the importance of community partnerships in public health emergencies, particularly in the context of highly transmissible diseases pathways.

Sputum and tongue swab molecular testing for the in-home diagnosis of tuberculosis in unselected household contacts: a cost and cost-effectiveness analysis.

Delayed and missed diagnosis are a persistent barrier to tuberculosis control, partly driven by limitations associated with sputum collection and an unmet need for decentralized testing. Household contact investigation with point-of-care testing of non-invasive specimens like tongue swabs are hitherto undescribed and may be a cost-effective solution to enable community-based active case finding. In-home, molecular point-of-care testing was conducted using sputum and tongue specimens collected from all household contacts of confirmed tuberculosis cases. A health economic assessment was executed to estimate and compare the cost and cost-effectiveness of different in-home, point-of-care testing strategies. Incremental cost effectiveness ratios of strategies utilizing different combination testing algorithms using sputum and/or tongue swab specimens were compared. The total implementation cost of delivering the standard of care for a 2-year period was $84 962. Strategies integrating in-home point-of-care testing ranged between $87 844 - $93 969. The cost-per-test for in-home, POC testing of sputum was the highest at $20·08 per test. Two strategies, Point-of-Care Sputum Testing and Point-of-Care Combined Sputum and Individual Tongue Swab Testing were the most cost-effective with ICERs of $543·74 and $547·29 respectively, both below a $2,760 willingness-to-pay threshold. An in-home, point-of-care molecular testing strategy utilizing combination testing of tongue swabs and sputum specimens would incur an additional 10.6% program cost, compared to SOC, over a 2-year period. The increased sample yield from tongue swabs combined with immediate result notification following, in-home POC testing would increase the number of new TB cases detected and linked to care by more than 800%. Evidence before this study: We searched PubMed for original research published between January 1, 1950 and June 30, 2024 that evaluated the cost-effectiveness of in-home POC molecular testing, as part of HCI strategies for tuberculosis. PubMed search terms used included ["household contact investigation" OR "household contact tracing"] AND "tuberculosis" AND "cost-effectiveness". The search revealed 8 studies, of which one was removed as HCIs were leveraged for the provision of short course preventative therapy and not tuberculosis testing. None of the studies were conducted in South Africa. All seven remaining studies relied on a hub-and-spoke model of sputum collection and transportation with sputum tested at a centralized laboratory facility. Although active case finding strategies like HCIs are endorsed by the WHO to improve early case detection and treatment initiation, limited research has been done to assess its cost-effectiveness in low- and middle-income countries.Added value of this study: To our knowledge, this is the first example of in-home molecular point-of-care (POC) testing as part of HCI. The use of primary data to estimate and compare the incremental cost effectiveness of different combination, in-home testing strategies utilizing alternative sample types equips policy makers with a selection of strategy options to choose from. The tradeoff between sample types with high collection yield and those with increased accuracy becomes evident in the economic analysis, highlighting the need to consider both yield and accuracy in effective clinical decision making and use-case development. The success of in-home, POC tongue swab testing of all contacts, irrespective of symptom presentation shows great promise for universal testing programs.Implications of all available evidence: Results from our economic modeling provide evidence in support for the integration of in-home, POC tuberculosis (TB) testing during HCI. The use of less invasive tongue swab samples to increase sample yield in the absence of sputum expectoration highlights the value of combination testing strategies. Immediate result notification resulting from rapid, in-home POC testing shows great promise for increasing early case detection and improving treatment uptake. In-home, POC testing strategies, when incorporated into HCI could curb ongoing community transmission and reduce the overall burden of TB. Considerations for adopting novel POC testing strategies in future active case finding programs like HCI should strongly be considered. We evaluated the cost-effectiveness of in-home, point-of-care TB testing of household contacts. The findings indicate that combined testing strategies using tongue swab and sputum specimens could significantly increase TB case detection, with modest additional program costs.

Early unrecognised SARS-CoV-2 introductions shaped the first pandemic wave, Sweden, 2020.

BackgroundDespite the unprecedented measures implemented globally in early 2020 to prevent the spread of SARS-CoV-2, Sweden, as many other countries, experienced a severe first wave during the COVID-19 pandemic.AimWe investigated the introduction and spread of SARS-CoV-2 into Sweden.MethodsWe analysed stored respiratory specimens (n = 1,979), sampled 7 February-2 April 2020, by PCR for SARS-CoV-2 and sequenced PCR-positive specimens. Sequences generated from newly detected cases and stored positive specimens February-June 2020 (n = 954) were combined with sequences (Sweden: n = 730; other countries: n = 129,913) retrieved from other sources for Nextstrain clade assignment and phylogenetic analyses.ResultsTwelve previously unrecognised SARS-CoV-2 cases were identified: the earliest was sampled on 3 March, 1 week before recognised community transmission. We showed an early influx of clades 20A and 20B from Italy (201/328, 61% of cases exposed abroad) and clades 19A and 20C from Austria (61/328, 19%). Clade 20C dominated the first wave (20C: 908/1,684, 54%; 20B: 438/1,684, 26%; 20A: 263/1,684, 16%), and 800 of 1,684 (48%) Swedish sequences formed a country-specific 20C cluster defined by a spike mutation (G24368T). At the regional level, the proportion of clade 20C sequences correlated with an earlier weighted mean date of COVID-19 deaths.ConclusionCommunity transmission in Sweden started when mitigation efforts still focused on preventing influx. This created a transmission advantage for clade 20C, likely introduced from ongoing cryptic spread in Austria. Therefore, pandemic preparedness should have a comprehensive approach, including capacity for large-scale diagnostics to allow early detection of travel-related cases and community transmission.

Trends in case detection rate for leprosy and factors associated with disability among registered patients in Zanzibar, 2018–2021

BackgroundLeprosy is still a disease of public health concern. Globally, 2–3 million people are thought to be affected by leprosy’s disease-related disabilities. Regarding leprosy status in Zanzibar, limited information is available. Determining changes in detection rates and factors associated with disability is crucial for treatment and preventative strategies for this debilitating disease. This study aimed to determine trends in case detection rate for leprosy and risk factors for disability among registered patients in Zanzibar, from 2018 to 2021. The study included all leprosy patients who received treatment in Zanzibar's 11 districts between 2018 and 2021. The study design used was an analytical cross-sectional. Prevalence and new case detection rate (NCDR) were calculated. Multivariable Poisson regression analyses were used to identify factors associated with leprosy disability. Crude and adjusted prevalence ratios (APR) and their respective 95% confidence intervals (CI) were reported. P-values ≤ 0.05 were considered significant.ResultsOf the 490 leprosy cases reported between 2018 and 2021, 469 (95.7%) were new patients, and 349 (71.2%) were multi-bacillary. The disease was found to be more common in males 296 (60.4%). The average prevalence was 7/100,000 population, while the average NCDR was 7/100,000 from 2018 to 2021. There was a significant decrease in disability grades from diagnosis to the end of treatment over 4 years (P < 0.001). Male sex (APR 1.55; 95% CI 1.18–2.04), advanced age (APR 5.01; 95% CI 1.91–13.17), multi-bacillary (APR 6.99; 95% CI 3.16–15.44) and HIV negative patients (APR 1.51; 95% CI 1.11–2.06) were more likely to develop physical disability.ConclusionThis study found that leprosy disability grades at diagnosis compared to the end of treatment declined during 4 years. There was no significant change in point prevalence and NCDR during the 4-year study period. Disability was associated with male sex, advanced age, multi-bacillary, and HIV-negative patients. To prevent leprosy-related disability and transmission, health education, early case detection, and adequate multidrug therapy should be prioritized.

EVALUATING PERINATAL OUTCOMES IN HIGH-RISK PREGNANCIES USING THE MODIFIED COOPLAND’S SCORING SYSTEM AT A TERTIARY HOSPITAL

This study aims to thoroughly assess perinatal mortality rates, Apgar scores, birth weights, and neonatal complications within the first-week post-birth among high-risk pregnancies. Methods: During a prospective cohort study at Jinnah Postgraduate Medical Centre, Karachi, from October 2023 to May 2024, we evaluated outcomes in 664 high-risk pregnant women using systematic random sampling. Participants, with singleton pregnancies of 24 weeks or more gestation, were stratified by risk level. Data included demographic details, socioeconomic status, BMI, and pregnancy history. Maternal outcomes, such as mode of delivery and postpartum haemorrhage requiring transfusion, and perinatal outcomes, including birth weight and APGAR scores, were assessed. Statistical analysis emphasized odds ratios, with p &lt; 0.05 considered significant. Ethical approval was obtained, and all participants provided informed consent. Results: This prospective cohort study at Jinnah Postgraduate Medical Centre from October 2023 to May 2024 involved 664 high-risk pregnant women categorized by standard risk scoring. Participants were predominantly low-risk (65.77%), followed by moderate-risk (19.88%) and high-risk (14.35%). Key findings included increased rates of cesarean sections, postpartum haemorrhage, premature births, low birth weight, adverse APGAR scores, NICU admissions, and perinatal mortality with escalating risk levels. Statistical analyses revealed significant associations and elevated odds ratios for adverse outcomes among higher-risk groups, underscoring the importance of risk assessment in managing maternal and perinatal health outcomes. Conclusion: Our study highlights the urgent importance of identifying and effectively managing high-risk pregnancies. We discovered that these pregnancies are associated with significantly elevated risks of complications such as Cesarean deliveries, postpartum haemorrhage, preterm births, low birth weights, low 5-minute APGAR scores, NICU admissions, and perinatal mortality. Implementing a straightforward, non-invasive risk-scoring system can facilitate early detection of high-risk cases, enabling timely and tailored interventions that can greatly improve outcomes for both mothers and infants.

B-048 Proposal of a new monitoring algorythm for patients with a HIV positive result with the Elecsys HIV DUO test

Abstract Background Worldwide HIV infections remain a public health problem, contributing significantly to morbidity. In Mexico we have had a progressive adaptation to the HIV epidemic providing free therapy and testing (4th generation tests) for the whole population in anbulatory centers for HIV/AIDS prevention and medical care. During 2022 Mexico reported 12,374 new cases. In the last decade there has been an increasing interest in the identification of patients HIV positives subgroups, based on disease progression and serological features. To date, 6 generations of tests for HIV detection have been developed, strongly reducing the window period for a positive result. Elecsys HIV Duo is a 5th generation immunological test that provides in a separate manner an antibody and antigen results for HIV detection. These results show a better insight of the serologycal status reducing the window period post infection. By using these tests we want to provide an early detection of new cases that gives a better prognosis for the patient and propose a new monitoring for patients with a positive antigen result but that have not yet produced antibodies. Such algorythm is currently lacking in the Mexican public health services. Methods A retrospective statystical analysis of HIV results of samples procesed with the Elecsys HIV DUO test during the january-april 2023 period in the National Reference Center of Salud Digna correlated with western blot results. Results The study population was 6405 patients, 6340 (98.98%) had a negative result in the test and 65 (1.02%) a positive test. Based in antibody/antigen results we categorized the positives results in three grupos: Group 1 Ab positive/Ag negative (16), group 2 Ab positive/Ag positive (32) and group 3 Ab negative/Ag positive (7). When correlated with the WB results all the patients from group 1 and 2 had a positive result while all patients in group 3 had a negative result. Conclusions Actually Mexican public health services do not have access to 5th generation HIV tests like the Elecsys HIV DUO test, therefore, public health profesional are not qualified to interprete these results and do not have a stated algorythm for patientes belonging to group 3. Therefore and based in our results we suggest 5th generation test (or superior if available) and propose a new patient monitoring algorythm with a molecular confirmatory test for viral detection. This proposal is strongly supported by the fact the we have a population that have not generated antibodys during the first weeks of post infection and will test negative in a serologycal confirmatory test like WB. Screening for patients in early infection stages is important because if we provide early therapy which may lead to infection reversal or a less impact in C4+ T cells numbers. Studies like this provide information for the generation of public politics in benefit of the population.

The effect of rehabilitation exercises in improving the range of motion and muscle strength of the muscles working on both sides of the spine for women aged (30-40) years

The research aims to relieve pain among women members of the research sample who suffer from low back pain, improve the muscle strength of the muscles working on both sides of the spine, and improve the range of motion of the spine. The researcher used the experimental method for one experimental group using the method of pre- and post-measurements as an experimental design due to its suitability to the nature and purpose of the research. Then The research sample was chosen intentionally from women with lower back pain, numbering (14) whose ages ranged between (30-40) years. Also, a number of (4) cases were randomly selected from the research community and outside the basic sample as an exploratory sample. The researcher used a rehabilitation program. Proposed for six weeks, the following results were reached: The use of various methods and methods helps to achieve a greater rate of improvement and in less time and cost. In light of this, the researcher recommends: Spreading awareness and culture among community members about paying attention to early detection of lower back pain to prevent the injury from worsening to advanced degrees. The research aims to reduce pain among women members of the research sample who suffer from lower back pain, improve the muscle strength of the muscles working on both sides of the spine, and improve the range of motion of the spine. The researcher used the experimental method for one experimental group using the pre- and post-measurement method as an experimental design due to its suitability to the nature and purpose of the research., The research sample was chosen intentionally from (14) women with lower back pain whose ages ranged between (30-40) years. Also, a number of (4) cases were randomly selected from the research community and outside the basic sample as an exploratory sample. The researcher proposed a six-week rehabilitation program. The following results were reached: - The rehabilitation program has a positive effect on the injured members of the experimental group. -The use of various methods and methods in the rehabilitation program, such as a physical therapy program, helps to achieve a greater rate of improvement and at a lower time and cost. In light of this, the researcher recommends: - Spreading awareness and culture among community members about paying attention to early detection of cases of lower back pain to prevent the injury from escalating to advanced degrees.

Amplitude do rastreio e diagnóstico do câncer de mama no estado do Piauí e o impacto da pandemia da COVID-19

Introduction: The COVID-19 pandemic has brought about a new epidemiological reality worldwide that is responsible for altering the entire dynamics of addressing health issues globally. Cancer management policies were directly impacted, potentially leading to a decline in early case detection and a consequent increase in morbidity and mortality among patients with cancer. Objective: To analyze the impacts of the pandemic on breast cancer screening measures in the state of Piauí. Method: This epidemiological study used secondary data provided by the Department of Health Information of the Brazilian Unified Health System regarding the performance of mammograms and breast cancer diagnoses in the state of Piauí between 2017 and 2021. Results: Between 2017 and 2019, an average of 39,165 mammograms were performed annually, compared with an average of 22,367 exams in each year between 2020 and 2021. The data presented in this study indicate a significant decrease in the number of exams performed, associated with a decline in the absolute number of diagnoses, as well as delayed diagnoses. Conclusions: The scenario described in this study suggests the possibility of developing an epidemiological emergency related to breast cancer, both due to the structural incapacity of the state of Piauí to provide adequate assistance to patients and the increasing observation of more advanced cases. Therefore, we highlight the need for intensified efforts to strengthen breast cancer management and early diagnosis strategies in the state of Piauí.

Accessibility of Finding Tuberculosis Case Actively, Separate Safely and Treat Effectively (FAST) Strategy for Early Detection of Suspected and Symptomatic Tuberculosis Patients: A Hospital Based Quantitative Study

Introduction: Tuberculosis is a contagious disease which has always been a challenge over the course of human history. It is known to spread mostly from persons with undiagnosed and suspected tuberculosis cases. Diagnosing tuberculosis in an early stage with effective treatment is one of the best ways to reduce the burden of tuberculosis. Finding cases Actively, Separate safely and Treat effectively (FAST) Strategy in Nepal, is a rapid diagnostic tool for rapid tuberculosis case detection. Aims: To access tuberculosis case Actively, Separate safely and Treat effectively (FAST) strategy for suspected and symptomatic tuberculosis patients coming to the hospital for early case detection and also to identify patient’s health care behaviour, technical barrier during surveillance. Methods: An observational quantitative study of active cough surveillance was carried at an entry point of FAST corner of Nepalgunj Medical College Teaching Hospital, Banke from April 2023 to December 2023. Scrutinized data was obtained by purposive sampling method with sample size 128 from FAST corner. Results: Maximum cases belonged to the aged group 65 and above having lower middle to lower socioeconomic status. Most of them were from joint family with contact history of tuberculosis in 35 (27.3) % of total cases. Out of total cases, 72 (56.25) % were confirmed with tuberculosis. Among those confirmed tuberculosis cases, multi drug resistance TB was found in 6 (4.7) %. Uses of mask was found significant (P&lt; 0.05) in our study although number of these health care behaviour were less appropriate. Pneumonia was a significant association 17 (P = 0.004) with tuberculosis patient. Insufficient volunteers, and limited Gene xpert machine were major barriers to implement FAST strategy screening in Hospital. Conclusion: FAST strategy is feasible tool in high tuberculosis burden healthcare settings in Nepal. However, the technical and behavioral factors should be managed to ensure an effective approach.

Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever at Jiblah University Hospital, Yemen

Background: Acute Rheumatic Fever (ARF) is an important and preventable cause of morbidity and mortality in developing countries including Yemen. Jones criteria provided a standardized approach for the identification of Acute Rheumatic Fever and facilitated an improvement in early case detection. Aims: To determine the extent to which physicians rely on Jones criteria to diagnose acute rheumatic fever in patients attending Jiblah University Hospital, Yemen. Materials and Methods: A hospital-based cross-sectional study was carried out at Jiblah University Hospital in Jiblah town, Yemen. Data of 71 convenience samples were collected through an open-ended questionnaire and analyzed using SPSS version 26. Results: Of 71 clinically diagnosed cases of ARF who tested high ASO titer, only 10 (14.1%) met the revised Jones criteria. Conclusions: The financial inability of patients to undergo Doppler echocardiography coupled with physician’s negligence about the importance of Jones criteria for diagnosing rheumatic fever and their reliance on high ASO titers for diagnosing rheumatic fever could lead to misdiagnosis of rheumatic fever in the study area.

Prevalence and Associated Risk Factors of Tuberculosis among Smear Positive Contact Individuals in Port Sudan

Background: Tuberculosis is a necrotizing granulomatous multisystem infectious disease that caused by mycobacterium, mainly mycobacterium tuberculosis, It is a serious global health problem that represent the commonest infectious cause of death. Many risk factors contribute in spread of tuberculosis, these factors include environmental factors, host factors and factors related to organism. Contact with smear positive patients is a major risk factors as every infectious patient can transmit the organism to ten to fifteen persons; therefore, contact tracing being an important element in DOTS (Direct Observed Therapy Strategy), because early detection and early management of cases prevent complication and improve the outcome. Objectives: This study aims to determine the prevalence and assess risk factors of tuberculosis among TB smear positive contact whose registered in Port Sudan chest hospital TBMU center during third and fourth quarters; June to December 2023. Methodology: This is a descriptive cross sectional community base study, Port Sudan, eastern Sudan, from June 2023 to December 2023. Result: The study shows that prevalence of tuberculosis among smear positive contact individual is 4.6%s. And it shows other associated risk factors has a role in spread of the disease. Conclusion: The prevalence of tuberculosis among smear positive contact individuals in Port Sudan is low comparing to literature and other studies due to strong tuberculosis program and stigma also play a role in this reduction. Tuberculosis spread more among female and elder contact as the spend more time in the home. And immunosuppression, poor ventilation and crowded household play an essential role in spread of tuberculosis.

The Role of Community Health Nurses in Handling Dengue Fever Outbreaks in Residential Areas

Controlling Dengue Hemorrhagic Fever (DHF) outbreaks is a complex public health challenge that requires collaboration from various stakeholders, including community health nurses. This study aims to assess the role of these nurses in managing DHF outbreaks in residential areas. Using a descriptive qualitative approach, the research involved in-depth interviews with community health nurses and direct field observations to gather comprehensive data. The findings revealed that community health nurses are crucial in preventing and controlling DHF outbreaks. Their responsibilities include educating the community about DHF prevention, identifying and managing mosquito breeding sites, and implementing environmental interventions. They also play a vital role in early detection of DHF cases and coordinate with government and health institutions for effective prevention and control measures. Furthermore, community health nurses provide counseling and training to raise awareness about DHF dangers and promote preventive actions. They are instrumental in encouraging community participation in environmental management to reduce mosquito habitats. This study emphasizes the need for ongoing support and capacity building for community health nurses to enhance their effectiveness. In conclusion, collaboration among health workers, communities, and stakeholders is essential to control dengue outbreaks and minimize the disease's impact.

Overview of Tuberculosis: Causes, Symptoms and Risk Factors

Tuberculosis (TB) remains a global health threat, exacerbated by factors such as drug resistance, co-infections, and social determinants of health. This comprehensive review examines various aspects of TB, including epidemiology, pathophysiology, diagnosis, treatment, prevention, and control measures. The bacterium Mycobacterium tuberculosis causes TB and primarily affects the lungs, although it can also affect other organs. Risk factors for TB include poverty, malnutrition, overcrowded living conditions, and immunocompromised states such as HIV/AIDS. Symptoms of TB include cough, fever, weight loss, and night sweats, but can vary depending on the site of infection. Diagnosis typically involves clinical evaluation, imaging studies, and microbiological testing, with rapid molecular tests such as the Xpert MTB/RIF assay revolutionizing TB diagnostics. Treatment consists of multidrug therapy for six to nine months, with drug-resistant TB requiring longer and more complex regimens. Prevention and control efforts focus on early case detection, treatment adherence, infection control measures, and Bacille Calmette-Guérin (BCG) vaccine vaccination. TB research and innovation aim to develop new diagnostics, drugs, and vaccines to improve TB control and treatment outcomes. Challenges to TB control include stigma, healthcare access barriers, and the rise of drug-resistant TB strains. Collaboration and advocacy efforts are essential for addressing TB in special populations, high-risk settings, and co-infection scenarios. Integrating a One Health approach, harnessing technology, and addressing climate change impacts is critical for advancing TB control efforts and achieving the goal of ending the global TB epidemic.

Effect of indoor residual spraying on sandfly abundance and incidence of visceral leishmaniasis in India, 2016–22: an interrupted time-series analysis and modelling study

Efforts to eliminate visceral leishmaniasis in India mainly consist of early detection and treatment of cases and indoor residual spraying with insecticides to kill the phlebotomine sandfly Phlebotomus argentipes that transmits the causative Leishmania protozoa. In this modelling study, we aimed to estimate the effect of indoor residual spraying (IRS) on vector abundance and transmission of visceral leishmaniasis in India. In this time-series analysis and modelling study, we assessed the effect of IRS on vector abundance by using indoor vector-abundance data (from 2016 to 2022) and IRS quality-assurance data (from 2017-20) from 50 villages in eight endemic blocks in India where IRS was implemented programmatically. To assess a potential dose-response relation between insecticide concentrations and changes in sandfly abundance, we examined the correlation between site-level insecticide concentrations and the site-level data for monthly sandfly abundances. We used mathematical modelling to link vector data to visceral leishmaniasis case numbers from the national Kala-Azar Management Information System registry (2013-21), and to predict the effect of IRS on numbers of averted cases and deaths. IRS was estimated to reduce indoor sandfly abundance by 27% (95% CI 20-34). Concentrations of insecticides on walls were significantly-but weakly-associated with the degree of reduction in vector abundance, with a reduction of -0·0023 (95% CI -0·0040 to -0·0007) sandflies per mg/m2 insecticide (p=0·0057). Reported case numbers of visceral leishmaniasis were well explained by trends in vector abundance. Village-wide IRS in response to a newly detected case of visceral leishmaniasis was predicted to reduce disease incidence by 6-40% depending on the presumed reduction in vector abundance modelled. Indoor residual spraying has substantially reduced sandfly abundance in India, which has contributed to reductions in visceral leishmaniasis and related deaths. To prevent the re-emergence of visceral leishmaniasis as a public health problem, surveillance of transmission and sandfly abundance is warranted. Bill & Melinda Gates Foundation. For the Hindi translation of the abstract see Supplementary Materials section.